Barnet Lane Clinic

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

Managers ensured staff had systems, processes and tools in place to assess patients care and treatment needs. The provider had processes in place to ensure patients received care, treatment and support that was evidence-based and in line with good practice standards. There were systems and processes in place to ensure continuity of care for patients with treatment needs or transitioning plans. Staff made sure patients had access to physical health care, including specialists as required. Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice. Managers made sure that staff could explain patients’ rights to them. Staff supported patients to make decisions on their care for themselves. They understood the trust policy on the Mental Capacity Act 2005 and assessed and recorded capacity clearly for patients who might have impaired mental capacity.

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 majority of patients confirmed their care and treatment needs were assessed and reviewed with them. Carers spoke positively about staff’s understanding of the needs of their relatives. Patients spoke about support they received with communication needs by using translation services. Commissioners shared that patients were provided with accessible information in the form of easy read and pictorial information. Patients and carers confirmed physical health needs were assessed and treated. Feedback from advocates and commissioners demonstrated that patients’ needs were assessed, and staff had a good understanding of the needs and risks of the patients.

Staff completed a comprehensive mental health assessment of each patient either on admission or soon after. Staff developed a comprehensive care plan for each patient that met their mental and physical health needs. Staff regularly reviewed and updated care plans when patients' needs changed. Care plans were personalised, holistic and recovery orientated. Staff completed positive behaviour support plans for patients, where applicable, so that staff were easily made aware of what triggers patients may have that led to challenging behaviours and what individualised interventions to use to support patients effectively.

We reviewed 6 patient care records. Care plans indicated that patients were involved in making decisions about their care and support and were written from their perspective. Staff ensured communication needs were met and used a translation service. Managers ensured staff had systems, processes, and tools in place to assess patients care and treatment needs.

Patients indicated they received care and treatment in accordance with best practice. Patients spoke about accessing psychological interventions and occupational therapy. They referred to group and individual activities they attended to support them with their recovery. Some patients referred to goals that they had set to work towards discharge. However, several patients and carers spoke about not having access to occupational or vocational opportunities to support them with their rehabilitation.

Managers ensured patients had access to a full range of specialists to meet their needs. Patients received care, treatment and support that was evidence-based and in line with good practice standards. Staff told us they completed a comprehensive multidisciplinary assessment on admission and care plans and risk assessments were reviewed regularly. Patients had access to a full multidisciplinary team including doctors, nurses, occupational therapists, and psychologists. Staff provided a range of care and treatment suitable for the patients in the service. Staff delivered care in line with best practice and national guidance. For example, doctors used High Dose Antipsychotic Therapy guidelines to ensure antipsychotic prescribing was within approved limits from the British National Formulary. Staff made sure patients had access to physical health care, including specialists as required. Staff met patients’ dietary needs and assessed those needing specialist care for nutrition and hydration. Staff helped patients live healthier lives by supporting them to take part in programmes or giving advice. Staff used recognised rating scales to assess and record the severity of patients’ conditions and care and treatment outcomes.

The provider had processes in place to ensure patients received care, treatment and support that was evidence-based and in line with good practice standards. The ward staff worked well together as a multidisciplinary team. There was clear input from occupational health and psychology teams. Managers ensured staff took part in clinical audits and used results from audits to make improvements.

Patients and carers generally felt that staff worked well with them to support their needs and care for them. Some carers felt that discharge plans were not in place for their relatives. Commissioners spoke about regular communication, updates, and involvement with staff about the patients they had placed at the service.

Staff gave examples of occasions where they had supported patients with transitioning towards discharge to another service and the time and support, they had provided patients with this.

We observed onsite staff interactions and working practices, multidisciplinary meetings, and reviewed care records. These demonstrated effective working across teams and services to support people. We saw evidence of some discharge planning and liaison with external stakeholders to ensure effective transitions were in place.

Managers ensured internal and external staff teams and stakeholders worked well together. There were systems and processes in place to ensure continuity of care for patients with treatment needs or transitioning plans. These were communicated effectively and co-ordinated well between services or teams.

Patients spoke about attending groups to improve their activity levels and food choices such as swimming, walking groups, yoga, and cooking sessions. Patients and carers were satisfied with the access to care and treatment to meet their physical health needs and to live healthier lives.

Staff made sure patients had access to physical health care, including specialists as required. Staff took patients to appointments and accessed emergency care where appropriate. Doctors completed audits to ensure they were conducting the correct checks for patients’ physical health on an annual basis. Staff assessed and supported patients to improve their physical health by providing information and access to groups to improve health and well-being.

Managers ensured patients had access to activities, annual health screening, physical health care and regular care and treatment reviews to ensure their health and wellbeing needs were being met. Our review of care plans, multidisciplinary meetings and care records confirmed this.

Carers completed an annual carers survey and attended the carers forum where they were able to give their feedback about the service. Patients completed an annual survey and attended community meetings where they were able to give feedback on their experiences at the service.

Staff used recognised rating scales to assess and record severity and outcomes. Managers held regular clinical governance meetings where care and treatment outcomes were monitored to improve outcomes. Managers used the information they obtained from patients and carers to make improvements to the service. Meetings contained actions to address with updates on the progress of these.

Managers ensured staff used patients care records to monitor and improve care and treatment. Managers audited care and treatment records and held action plans to continuously improve this. For example, staff conducted audits on physical health monitoring, infection control, handwashing, health and safety, observations, and care plans.

Patients were aware of and understood their rights around consent and the care and treatment they received. Carers were consulted with and invited to best interest meetings, where appropriate. Patients had easy access to information about independent mental health advocacy and patients who lacked capacity were referred to the service.

Staff demonstrated an understanding and commitment to ensuring patients were aware of and understood their rights and consent was sought from them prior to care and treatment decisions so that patients could make informed decisions. Staff requested an opinion from a Second Opinion Appointed Doctor (SOAD) when they needed to. Staff stored copies of patients’ detention papers and associated records correctly and staff could access them when needed. Staff received and kept up to date with training on the Mental Health Act and the Mental Health Act Code of Practice and could describe the Code of Practice guiding principles. Staff had access to support and advice on implementing the Mental Health Act and its Code of Practice. Staff received and kept up to date with training in the Mental Capacity Act and had a good understanding of at least the five principles. Staff gave patients all possible support to make specific decisions for themselves before deciding a patient did not have the capacity to do so. Staff assessed and recorded capacity to consent clearly each time a patient needed to make an important decision. When staff assessed patients as not having capacity, they made decisions in the best interest of patients and considered the patient’s wishes, feelings, culture, and history.

Our observations of staff and patient interactions indicated that consent was sought from patients prior to any care intervention or treatment. Care records and multidisciplinary meetings demonstrated patients were being informed of their rights, people’s capacity, and ability to consent were taken in to account, carers, families and advocates were consulted with, and capacity assessments and best interest meetings were held, where appropriate.

Managers ensured the service had clear, accessible, relevant, and up-to-date policies and procedures that reflected all relevant legislation and the Mental Health Act Code of Practice. The provider had systems and processes in place to ensure that people understood the care and treatment being offered so they could make an informed decision. Staff conducted audits of rights being read to patients to ensure this was being regularly completed. Mental Health administration staff regular reviewed and checked mental health act paperwork to ensure these were correct. Care records demonstrated evidence of patients being informed of their rights and capacity assessments being conducted and reviewed. Staff conducted and recorded best interest decisions.