Barnet Lane Clinic

On this page

• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

Patients and carers we spoke with were generally positive about the service and said they were treated with kindness, compassion, and dignity. People felt that staff listened to them and communicated with them appropriately, in a way they could understand. We observed staff supporting patients with their individual needs and preferences as reflected in their care plans. Patients’ care plans reflected their holistic needs and preferences. Patients told us that they were supported to have choice and control over their care and to make decisions about their care and treatment. They confirmed that staff made sure they understood their rights and reviewed this regularly throughout their care and treatment. Patients we spoke with were generally satisfied with staff responses to their immediate needs. They said that staff observed and communicated with them and prioritised their views, wishes and comfort as far as possible. Staff told us that the provider recognised and met their wellbeing needs. Staff said they had opportunities to provide feedback, raise concerns and suggest ways to improve the service or staff experiences. The management team were responsive in arranging for improvements to be made, forming action plans and following these up to ensure that changes were embedded. However, some patients described the service as hectic, and a small number of patients described seeing some staff sleeping on some night shifts or staff speaking other languages in front of them. Some carers reported problems with the service’s phone lines, and a lack of communication with them (areas that the service told us they were addressing). We found a breach of the legal regulation in relation to person centred care. Two patients said that there were sometimes not enough female staff on duty, so that when on enhanced observations, they might have to wait to use the toilet or shower facilities.

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.

Most patients and carers we spoke with were very positive about the service and said they were treated with kindness, compassion, and dignity. People felt that staff listened to them and communicated with them appropriately, in a way they could understand. Some patients described the service as hectic, and a small number of patients described seeing some staff sleeping on some night shifts or staff speaking other languages in front of them. Carers were also positive about the way their relative were supported at the service. However, some carers reported problems with the service’s phone lines. Managers were transitioning to a new phone provider and had put in measures to minimise the disruption this had caused. Carers also raised a lack of communication with them which managers were addressing. Carers were invited to ward rounds and other relevant meetings about their relatives’ care if patients gave permission. A carers meeting was held in March 2024, during which topics discussed included having a designated key contact for each carer, improvements to the reception area, and sharing the monthly newsletter. It was agreed that these meetings would be held at least quarterly.

Staff we spoke with understood the needs and preferences of patients and spoke of how they supported them sensitively and with compassion. They noted that it had been unsettling for patients as building work was being undertaken on the hospital site, and how they were trying to reassure patients about proposed changes to the service. Staff who had remained at the service since the change over to the new provider told us that the new provider cared about patients and staff at the service and was investing in bringing about improvements for them. Staff and visitors confirmed that patients on the male ward in the hospital were more isolated, but staff made an effort to engage with them as far as possible. Male patients were aware that they would need to find alternative accommodation when the hospital moved to accommodating only female patients. However, they did not feel any pressure to move on at the time of the inspection.

Feedback from people who visited the service regularly included commissioners and an advocate, who were very positive about the atmosphere at the service. They confirmed that staff were open and proactive in dealing with safeguarding concerns. An advocate attended the hospital every week, and joined in the patients’ community meeting, finding staff and management open and approachable, responding to any concerns promptly. They noted that some patients had raised issues around some staff sleeping at night whilst on observations, the responsiveness of some agency staff and some female patients experiencing delays in having their needs being met.

There was a pleasant atmosphere in the service during our inspection visits. We observed that patients’ privacy and dignity was respected and upheld at all times. The environment was comfortable, light, and airy, and air conditioning was provided in all rooms. Due to the location of the hospital on a busy road, a smoking area was being provided within the spacious grounds. People were generally assured that information about them was treated confidentially. However, we did find that some patient information was visible from windows in a small number of staff areas. We reported this to the registered manager, who advised that they had plans to address this issue by the installation of blinds.

Patients told us that staff knew and understood their needs, preferences, and wishes. They said that their personal, cultural, social, and religious needs were understood and met. They noted that they sometimes had less responsive care from agency staff who did not know their needs so well. Most patients were aware that they could have a copy of their care plans, although few wanted to have a copy. People’s communication needs were met to enable them to engage in their care, treatment, and support to maximise their experience and outcomes. For example, translations and interpreting services were provided for one patient as needed. Patients generally said that staff treated them as individuals, considering any relevant protected equality characteristics. However, one patient noted that they had observed a patient being addressed without using their pronouns. A small number of patients said that sometimes staff talked between themselves in a language other than English. Some carers thought that staff needed more training and experience in working with patients who had autism. Patients and carers confirmed that there were not enough educational and employment opportunities, and few activities at weekends to meet their needs and preferences. The registered manager indicated that these were areas that had been identified for improvement by the management team.

Staff we spoke with were knowledgeable about individual patients’ needs and gave examples of how they supported different patients according to their needs and preferences. For example, patients were supported to use mobility aids according to their preferences, and some patients were supported to administer their own medicines and cook their own meals with differing levels of support according to their needs.

We observed staff supporting patients with their individual needs and preferences as reflected in their care plans. At staff handovers and other multidisciplinary meetings, staff discussed patients’ individual needs in sufficient detail to ensure that they provided holistic support.

Patients’ care plans reflected their holistic needs and preferences. Patients’ electronic records noted whether patients had chosen to have a copy of their care plan. There were positive behavioural plans undertaken by the psychologist in place for patients who would benefit from this. There were systems in place to provide care plans translated into different languages or easy read format. Managers had a plan to develop the format of daily planning meetings with patients further to make these more meaningful.

Patients told us that they were supported to have choice and control over their care and to make decisions about their care and treatment. They confirmed that staff made sure they understood their rights and reviewed this regularly throughout their care and treatment. Patients confirmed that they were supported to maintain relationships and networks outside of the hospital and they had regular contact with their friends and family. People were happy with opportunities to be involved in activities in the local community including swimming and gym sessions, and shopping and social trips to promote and support their independence, health, and wellbeing. They had opportunities to develop independence skills such as taking their medicines independently, cooking and budgeting.

Staff gave examples of how they supported people to develop their independence skills. They described formulating care plans in partnership with patients, and a stepped approach to supporting people with tasks such as cooking their own meals or managing their own medicines. They supported people to maintain relationships and networks outside of the hospital as far as possible. There were a range of activities available to patients within and outside of the hospital. Staff spoke of plans to increase the range of activities available to people within the hospital and the local area to promote and support their independence, health, and wellbeing.

We observed patients being supported by staff to be as independent as possible, and support needs were discussed during the staff handover meeting. We saw people going out to activities within the local community with varying support depending on their needs. There was a wide range of appropriate equipment to support and maximise people’s independence and outcomes from care and treatment including mobility aids, an accessible kitchen, and art room.

Care plans indicated that patients were involved in making decisions about their care and support and were written from their perspective. Visitors to the service including commissioners and an advocate indicated that there was a culture of respect between colleagues from other organisations. Patients were able to raise concerns or suggestions for improving the service directly to staff, through regular community meetings, and with support from an advocate if preferred.

Although patients generally felt confident that staff would respond to their needs quickly and efficiently, two patients said that there were sometimes not enough female staff on duty, so that when on enhanced observations, they might have long waits to use toilet or shower facilities. The hospital advocacy service confirmed that this issue had been raised with them also. We raised this issue with the hospital’s management, who undertook to look into this. Managers and staff told us that there were processes in place to swap male for female staff on observations in such cases. However, patients we spoke with were generally satisfied with staff responses to their immediate needs. They said that staff observed and communicated with them and prioritised their views, wishes and comfort as far as possible. Staff gave them help, emotional support and advice when they needed it. They noted that staff were often able to anticipate their needs to prevent concerns or distress. Most carers we spoke with were also satisfied with staff responses to their relatives’ immediate needs. One patient raised concerns that they could not speak with the doctor as often as they wished, but we saw evidence of regular meetings with the doctor and other staff to discuss their concerns.

Staff told us how they worked to meet patients’ needs, through engagement whilst carrying out observations, and knowledge of patients’ different needs and priorities. They said that there were usually enough staff on shift to meet patients’ immediate needs, except in the event of a serious incident, during which this could mean that patients had to wait longer for support, if a significant number of staff were needed elsewhere.

We observed staff engaging with patients sensitively and meeting their needs during our inspection visits. At staff handover meetings staff discussed people’s needs, and those requiring priority for their physical or mental health.

Managers ensured that policies and procedures prioritised people’s needs, views, wishes and comfort. Staff understood their duties to anticipate and respond to patients’ needs to prevent discomfort or distress. Patients’ care plans detailed their needs and how they preferred to be supported and were reviewed regularly.

Staff told us that the provider recognised and met their wellbeing needs. They described appropriate resources and facilities for safe working, and regular breaks scheduled. Staff said they had opportunities to provide feedback, raise concerns and suggest ways to improve the service or staff experiences. The management team were responsive in arranging for improvements to be made, forming action plans, and following these up to ensure that changes were embedded. Staff said that they had support available to them if they were struggling at work and described good team working and a positive atmosphere at the service which had improved the atmosphere for patients also. They said that they were encouraged to undertake professional development and had no concerns about any discrimination within the service. They felt valued by the management team. Recently managers had arranged a staff appreciation event at the hospital, involving all patients and staff, with cakes, decorations, and appreciation posters.

The management team spoke about the processes of moving the service to a new provider, and the impact this had on staff wellbeing, turnover and the need to develop a new team. They had an action plan in place to follow up on the most recent staff survey from 2023. They were interviewing for 2 night-coordinators at team leader level, to provide more engagement with patients in the evenings. They were also considering recruiting another activity coordinator to have more input at weekends if funds were available. The management team provided a weekly update for staff, including welcoming any new staff, a focus topic (such as management of patient property), training opportunities, forthcoming events, and feedback from patients and carers. The hospital manager had set up breakfast meetings with staff, to speak about their experience and any areas for improvement. Most recently this had led to improvements in the hospital security systems for items coming in from outside the hospital and better and fairer allocation of duties at shift handovers.