Derbyshire Healthcare NHS Foundation Trust

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

All patients we spoke to felt staff were kind, respectful and approachable. However, some patients told us some staff discussed their personal life which they found distressing and because the wards were often short staffed they felt they could not approach staff for support. No partners we spoke to raised concerns about the way patients were treated by staff and all felt that if they raised any concerns staff would respond to these immediately. We saw patients had free access to their rooms throughout the day and could access snacks and drinks too. Carers raised concerns at the number of times patients were able to tie ligatures on numerous occasions and patients told us they could not always approach staff due to them being so busy.

This service scored 65 (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 at the Radbourne Unit said staff were most kind and considerate, however they said staff disclosed details of their personal life which they found distressing. The majority of patients at the Hartington Unit told us that staff were respectful, kind, compassionate and approachable. However, some patients told us that they struggle to find privacy on the ward and the hub is sometimes overcrowded. They felt that because the wards don’t have enough staff they are unable to approach staff for support and they get ‘told off’ if they stand at the nurses station waiting to ask questions.

Staff at the Radbourne Unit said they could raise concerns about disrespectful, discriminatory or abusive behaviour or attitudes towards patients without fear of the consequences. Staff at the Hartington Unit told us that management are very supportive and always have time to listen. That overall, the unit has a culture of kindness and respect. However, some staff had experienced disrespect from their peers on the ward. Medical staff felt supported by the trust medical director and clinical director.

We spoke to partners from the local authority, local integrated care board and the advocacy service. No partners raised any concerns around the way staff treated patients. Partners told us staff responded to concerns raised by patients. Partners told us staff planned detailed individualised discharge plans taking into consideration patients individual care needs.

At the Radbourne Unit we observed caring interactions between staff and patients especially in activity sessions. We observed staff at the Hartington Unit engaging in a kind and compassionate way with patients on the ward. When patients were distressed we observed staff supporting other patients and moving them away from the area to maintain the patients dignity. We observed staff engaging in activities with patients and consoling them when they were distressed. We observed a ward round where the MDT showed empathy and understanding towards a patient who was worried about leaving the ward for their section 17 leave. They provided emotional support and reassurance to the patient.

Patients we spoke with at the Radbourne Unit said staff knew them well and treated them as individuals. Most patients we spoke to at the Hartington Unit said that staff treated them as individuals and provided support and treatment which met their needs and preferences. Patients were offered translators if English was not there first language, and the unit provided a spiritual room that patients could access.

Staff at the Radbourne Unit were able to describe how they involved patients in the planning of care to tailor this to individual needs. Staff we spoke to at the Hartington Unit treated patients as individuals and worked with them to meet their needs and preferences. Our review of care records showed that staff took individual differences into account, for example one care record showed that transparent and compassionate conversations were recorded around reducing dependence on addictive medications. Patients views were respected, and staff offered patients the opportunity to challenge and appeal decisions through a formal request procedure. Patients were also offered support with smoking such as nicotine patches to be prescribed. Staff we spoke to knew individual patients well and were keen to help support their interests.

At both the Radbourne and Hartington Units we observed staff treating people as individuals, making sure that their care support and treatment meets their needs and preferences. At the Hartington Unit we also observed a coping skills group where 7 patients attended, including a patient with a visual impairment. The Occupational Therapist sat next to the patient and support them to take part in the session. Activities in the hub could not be accessed by all patients due to the individual risks of the patient. Where possible alternative session were offered. We observed a cooking session and a PAT dog group where 5 patients took part.

Care plans we reviewed showed patients had been involved in their development and they included patients preferences.

Patients at the Radbourne Unit told us they had free access to their bedrooms, where deemed clinically appropriate. Food was provided inhouse. The wards had a spacious lounge area and a quiet de-escalation room. Patients said there was a limited choice of food for people with preferences for dietary or religious reasons. The majority of patients at the Hartington Unit told us that they knew their rights and they were treated with dignity and respect. Patients were able to meet with their friends and family so they could be supported during their treatment and had free access to their bedrooms when they were on the ward. However, some patients told us that they were not aware of their rights and found it difficult to find privacy on the unit. Patients also told us that they did not have access to their care plans and that the food was adequate, but there could be more choice.

Staff we spoke with at the Radbourne Unit said they worked with patients and families to maintain their independence. This was discussed at the ward round meeting. At the Hartington Unit the majority of care records were comprehensive and had information about patients’ rights. During MDT meetings patients were involved in discussions about their rights and section 17 plans were discussed collaboratively. Patients were given options by staff to help them manage and facilitate successful discharge including discussing protective factors to help manage their wellbeing away from the ward. 132 rights and rights of appeal were also discussed by staff.

At the Radbourne Unit we saw access to hot and cold drinks was available as were snacks. Patients could access fresh air and informal patients were free to leave the ward at any time. At the Hartington Unit we observed patients independently accessing the hub, where they were able to go into the garden, with support where appropriate, to access fresh air. Informal patients were able to leave the ward at any time and patients had access to the kitchen to make hot and cold drinks. Snacks were also available for patients 24/7. We observed patients playing pool in the hub and using the lounge on the ward to listen to music and watch TV independently.

Patients at both Radbourne Unit and Hartington unit had access to an independent advocate. The advocacy service told us they attended the wards regularly and received referrals from the wards. The wards had displayed their posters allowing patents to be able to access their services independently. They felt staff responded well to concerns raised. All wards at Radbourne and Hartington unit had weekly community meetings in place where patients could discuss areas impacting them including visiting times, vapes, care planning, meals and areas of improvements. Where actions were identified they would be noted and reviewed at the next meeting.

We spoke with 3 carers at the Radbourne Unit. 1 family member raised concerns about their family members behaviour, such as swallowing batteries, rings, and coins. Despite raising their concerns and nurses staff intervening the behaviour continued. 1 carer expressed serious concerns about the patient's recurring tendency to tie ligatures, which poses a significant risk. They stressed this as another ongoing issue causing them great worry. We spoke to 24 patients at the Hartington Unit who provided a mixed picture in relation to staff responding to their needs. Most patients felt that their needs were met and staff were visible on the ward. However, some patients reported that due to staff shortages their immediate needs were not always met. One patient said that staff ‘tell them off’ when they stand around the nursing station. The patient explained that they do this so they can ask questions when the nurses are not busy. A number of patients said they don’t feel they can approach staff because they’re too busy.

Three members of staff at the Radbourne Unit told us that due to the wards being short staffed they were unable to respond to patient requests to leave the ward in a timely way. Staff at the Hartington Unit told us that due to staff shortages it was often difficult to provide 1:1 care for patients. They explained that the increased acuity of patients meant that their immediate needs were not always met. Staff told us they wanted to engage more in therapeutic activities, such as providing escorted walks, but couldn’t due to staff shortages.

At the Hartington Unit we observed staff responding to a patient who was in discomfort due to a physical health problem. The ward Dr assessed the patient and recognised they needed to go to A&E for immediate attention. The ward staff worked together to calm the patient and minimise distress to allow transportation to the hospital.

Both Radbourne and Hartington units had an on-call rota in place. The rota showed specific cover for industrial action days and clearly showed the medics and consultants available.

We did not look at Workforce wellbeing and enablement during this assessment. The score for this quality statement is based on the previous rating for Caring.