Ellern Mede Barnet

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

Our overall rating of effective at Ellern Mede Barnet has improved and is now good. We assessed 6 quality statements. Staff assessed the physical and mental health of all patients on admission. They developed individual care plans which were reviewed regularly through multidisciplinary discussion and updated as needed. Care plans reflected patients’ assessed needs, and were personalised, holistic and recovery oriented. The service now had access to a full multidisciplinary team. The occupational therapist and clinical psychologist vacancies had been recruited into. This meant that patients were offered a range of therapeutic support. Staff delivered treatment in line with best practice and evidence-based guidance. Staff met patients’ dietary needs and assessed those needing specialist care for nutrition and hydration. Patients were supported to live healthier lives. Both adult consultant psychiatrists had now completed their mandatory and CAMHS training. 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. Outcome measures were used to monitor patient outcomes and provide assurance that the treatments and interventions being used were having a positive effect on patients’ recovery.

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, and where appropriate families, were involved in pre-admission assessments to establish their care and support needs. Patients told us they had copies of their care plans and most said they felt included in formulating their care plans. Patients attended ward round meetings every fortnight. Patients were able to provide written feedback if they wished to do so for the ward meetings. Updates to plans were fed back by the nursing staff and discussed with the patient if they did not attend the meeting.

Staff told us patients had a comprehensive mental health and physical health assessment on admission or soon after. Patients had their physical health assessed soon after admission and regularly reviewed during their time on the ward. Staff recorded patients’ vital signs, which included regular weights. All patients had a formal assessment of their nutritional status carried out by a qualified dietitian on the day of admission, in line with best practice. Staff regularly reviewed and updated care plans when patients' needs changed.

Staff supported patients with their physical health needs and worked collaboratively with specialists when needed. Comprehensive physical assessments were completed and plans for on-going monitoring of health conditions and healthcare investigations were developed. This included regular monitoring of blood samples, heart rate, pulse, urine tests, temperature, weight monitoring, BMI (body mass index), the sit up, squat and stand up (SUSS) test of muscle function in anorexia nervosa and electrocardiogram (ECG). Bone density scans were completed for patients who needed them. Staff developed a comprehensive care plan for each patient that met their mental and physical health needs. We saw care plans related to a patient’s mental health needs, their physical health needs, nasogastric feeding, and any dining room support needs. Care plans included patient views. Care plans were personalised, holistic and recovery orientated. Individual plans to treatment were clearly demonstrated in the Patient Inclusion in Least Restrictive Intervention Management Plan (PILRIMP).

Patients told us they had copies of their care plans and most felt included in formulating their care plans. One patient told us they did not agree to the ‘feeds’ in their care plan. Patients were offered medications, 1:1 sessions and psychology sessions from staff as part of their treatment. Patients told us there was a lack of structured activities through the week, and especially at the weekend.

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Managers ensured staff had systems, processes, and tools in place to assess patients care and treatment needs. Staff met patients’ dietary needs and assessed those needing specialist care for nutrition and hydration. The dietician and dietician assistant carried out comprehensive nutritional and hydration assessments for all patients upon admission to the service to ensure that refeeding was carried out safely including nasogastric feeding. Records showed all patients’ physical health risks were assessed on admission by a doctor and included an assessment of the risk of refeeding syndrome and malnutrition. Staff made sure patients had access to physical health care, including specialists as required. Patient records showed appropriate referrals being made. The hospital had links with their local hospital emergency departments to ensure arrangements were in place if one of their patients needed to visit the hospital. This was to ensure better joint working and a better experience for patients and staff. Managers identified any training needs their staff had and gave them the time and opportunity to develop their skills and knowledge. The doctors considered National Institute for Health and Care Excellence (NICE) guidance when prescribing medicines. Treatments for eating disorders were also based on national guidance which included managing emergencies in eating disorders (MEED).

Patient’s views regarding information sharing were respected.

Staff told us team members from different disciplines worked together as a team to benefit patient’s care. They described close and supportive working relationships with other professionals. Staff held weekly multidisciplinary ward rounds to discuss patient’s care and treatment. All staff involved in the care of the patient were involved in this meeting to provide feedback and update care plans. Staff also updated the team if they would be meeting with a patient that day. The hospital had effective working relationships with external teams and organisations.

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. The hospital held regular reviews with commissioners and care coordinators.

Staff helped patients live healthier lives by supporting them to take part in programmes or giving advice. Patients spoke about attending groups to improve their activity levels and food choices such as swimming, walking groups, yoga, and cooking sessions.

Staff helped patients live healthier lives by supporting them to take part in programmes or giving advice. Consultants referred patients for physiotherapy where required. The physiotherapist developed exercise plans for individual patients. They also used a visual reality headspace to support patients to exercise in a safe space. Staff supported patients with activities outside the service, such as work, education and family relationships.

Staff made sure patients had access to opportunities for education and work, and supported patients to access this, for example staff reported how they supported a patient to attend university lectures online. 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.

Carers completed an annual carers survey and attended Care Programme Approach meetings 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.

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.

Staff used recognised rating scales to assess and record the severity of patients’ conditions and care and treatment outcomes. For example, the hospital used the Health of the Nation Outcome Scales (HoNOS) Children's Global Assessment Scale (CGAS) regularly to monitor patient’s progress, symptoms and wellbeing. The service monitored the effectiveness of care and treatment and used the findings to improve them. The service completed clinical audits in areas such as care and treatment, consent and capacity, and safeguarding. Any actions from the audits were being monitored through clinical governance meetings and through the site improvement plan.

All patients had access to the mental health advocacy service. The advocate would offer sessions to individual patients on request such attending their Care Programme Approach meetings and/or multidisciplinary team ward round meetings. Staff ensured people were able to make an informed choice and understood what was being planned. Care plans gave clear guidance for staff to ensure explanations were provided to people about their care and treatment, and their views respected.

Staff spoke about how they assessed and recorded consent and capacity or competence clearly for patients who might have impaired mental capacity or competence. The capacity of patients to make decisions was always considered in multidisciplinary discussions.

Staff had an excellent understanding of their responsibilities around the Mental Capacity Act and the need for best interest decisions to be made for people who lacked the mental capacity to make these decisions for themselves.

Staff assessed and recorded consent and capacity or competence clearly for patients who might have impaired mental capacity or competence. Capacity was assessed on admission and at weekly multidisciplinary meetings. Capacity was also reassessed after an incident, for example where patients had self-harmed. Staff received and kept up to date with training in the Mental Capacity Act and Deprivation of Liberty Safeguards. All staff had completed training in Gillick competence. Staff gave patients support to make specific decisions for themselves before deciding a patient did not have the capacity to do so. Records showed capacity was assessed regularly by measuring a patient’s ability to understand, retain and weigh up information before determining that they lacked capacity. 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. Patients had easy access to information about independent mental health advocacy and patients who lacked capacity were automatically referred to the service.