Cheshire and Wirral Partnership 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

We assessed a total of 4 quality statements in the caring key question. The scores for these areas have been combined with scores based on the rating from the last inspection, which was good. Our rating for this key question is good. Feedback from patients and carers was that staff were caring, compassionate and supportive. The trust sought feedback from patients and carers using a patient survey and friends and family test. Staff demonstrated caring attitudes, and we heard examples from staff on understanding and including patients in their care. Example were providing complaints information to patients (QR code on leaflet). Feedback from managers was the service rarely received complaints about staff conduct. Patients were asked for their preferred pronouns, and read notes beforehand to avoid patients having to repeat information. Patients were signposted to third sector organisations (voluntary/charities/private ) for support including crisis cafes, and social and leisure activities. Partners were complimentary about the role of the street triage service, helping patients avoiding having to go to accident and emergency departments and health based places of safety. The first response model supported patients to access an assessment quickly and either assess them for further care and treatment, or signpost them to a more appropriate service, reducing the need for lengthy waits in accident and emergency. The crisis line was available 24 hours a day, and anyone could access this to get further advice and support. This was part of NHS 111 mental health services and call waiting times monitored with plans in place if there were delays.

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.

People feel they are treated with kindness, compassion and dignity in their day-to-day care and support. We received positive feedback from patients and carers about staff , who were described as "compassionate", “nice” and "supportive". People feel that staff listen to them and communicate with them appropriately, in a way they can understand. People feel that staff know and understand them, including their preferences, wishes, personal histories, backgrounds and potential.

People’s privacy and dignity was respected and upheld at all times. Liaison psychiatry staff said when they interviewed patients in the main accident and emergency area, they made sure privacy curtains were in place. People were assured that information about them was treated confidentially and they knew that staff respected their privacy. Liaison psychiatry staff interviewed patients in the mental health rooms located in accident and emergency departments where possible to maintain confidentiality. Staff demonstrated caring attitudes, and we heard examples from staff on how they included patients' understanding and providing feedback on their care. Examples given were providing complaints information to patients (QR code on leaflet). Feedback from managers was the service rarely received complaints about staff conduct. Patients were asked for their preferred pronouns, and staff read patients’ notes beforehand to avoid patients having to repeat information.

Partners were complimentary about the role of the street triage service, helping patients avoiding having to go to accident and emergency departments and health based places of safety.

There was a culture of kindness and respect between colleagues from other organisations. In our observations of meetings, and general observations staff behaviours towards patients were positive and caring. They spoke with patients in a friendly but professional and supportive manner, and spoke about patients in a positive and caring way. Staff asked or explained any medical terminology and avoided using acronyms to explain care and treatment options to patients. The first response model supported patients to access an assessment quickly and either assess them for further care and treatment, or signpost them to a more appropriate service, reducing the need for lengthy waits in accident and emergency. The crisis line was available 24 hours a day, and anyone could access this to get further advice and support. This was part of NHS 111 mental health services and call waiting times monitored with plans in place if there are delays.

We did not look at Treating people as individuals during this assessment. The score for this quality statement is based on the previous rating for Caring.

People were supported to have choice and control over their own care and to make decisions about their care, treatment and wellbeing. All patients had an assessment and were very clear about their care plan and what would happen next. Patients were positive about the service and were aware of where to go to for support, and were involved in decisions about their care. Patients were signposted to community activities and support including crisis cafes and third sector organisations. Carers we spoke with were generally positive about the service.

Patients were supported to understand their rights by using different ways to communicate. Their understanding was reviewed throughout their care and treatment. Staff carried out detailed assessments of people, and offered them choices, promoting independence and followed least restrictive practice to promote patients choice in their care and treatment. This included support with medicines, to accessing advice for housing, finances or advocacy to understand their rights. Patients could access more specific support around grief, suicide, sexual assault, or carers advice. If required, staff could support people to get specialist equipment or access to interpreters. Feedback from managers was the service rarely received complaints about staff conduct. Patients were asked for their preferred pronouns, and staff read notes beforehand to avoid patients having to repeat information.

We observed staff discussed options available for people, which included options for someone who didn’t want to engage, and what their preferred communication methods were. We observed when staff discussed options with patients their approach was person centred, included options to be referred to other services, or have a more detailed assessment. We observed the same approach when staff engaged with relatives and carers of patients and kept them informed if a patients circumstances changed during an assessment, for example referring to another service or an inpatient admission.

There was a range of appropriate information to support and maximise people’s independence and outcomes from care and treatment. The trust had an autism strategy and an autism lead with whom first response actively collaborated with. There were five key areas that the trust were focusing on: staff training and awareness, including Oliver McGowan; service accessibility primarily related to communication; individualised support plans, including use of the green light tool kit and feedback mechanisms involving patients in collaboration and co-production. Leaflets had been co-developed with autistic people to support staff in working with them. Care records showed people were offered choices, and care was discussed with them. Account was taken of people’s preferences and needs as to how and where their care and treatment took place.

Patients' needs, views, wishes and comfort were a priority and staff quickly anticipated these to avoid any preventable discomfort, concern or distress. People were generally positive about the service. Patients referred to waiting for calls to the crisis line to be answered , one had waited 40 minutes. Patients highlighted the waiting times in accident and emergency were not due to liaison psychiatry staff assessment but for admission to a general ward. Patients said their initial crisis support was good and another that they had been referred to a homeless service.

Feedback was the first response model helped staff to see people quickly and either assess them for further care and treatment, or signpost them to a more appropriate service, reducing the need for lengthy waits in accident and emergency. The crisis line was available 24 hours a day, and anyone could access this to get further advice and support. Patients had access to a translation service should this been needed. Staff were alert to people’s needs and take time to observe, communicate and engage people in discussions about their immediate needs. They found out how to respond in the most appropriate way to respect their wishes. There were multidisciplinary reviews of patients to discuss their needs so an appropriate response to people who frequently attend accident and emergency departments could be made.

Waiting times for calls to the crisis line were monitored, and there could be long waiting for a call to be answered at times, but on average they were answered between 2.5 and 4 minutes. This had improved form several months ago when waiting times were up to 8 minutes. The first response co-ordinators are based in the first response hub. The first responders from home treatment, crisis line and liaison psychiatry took it in turn to be the first responder.

Staff could quickly recognise when people needed urgent help or support and use appropriate tools and technology to assist. The first response model meant patients were assessed quickly and further assessment for further care and treatment, or signpost them to a more appropriate service, reduced the need for length of waiting times for the Trust patients in accident and emergency departments.

Staff were supported at work, but they reported changes in their working practices had a negative impact, but this did not translate into the care they delivered to people. The majority of staff we spoke with felt supported within their local teams and by their local managers, but less so by senior managers. Staff had mixed views about the changes to the service and the adoption of the first response model. There had been consultation, and staff were broadly aware of why the changes were being made and saw positive aspects of it. However, the consultations have been some time ago, and the actual changes had been implemented very suddenly. Staff felt this had put them at increased pressure, and their views were their concerns were not being listened to or acknowledged and some staff were unclear about the expectations of them in their new role. The feedback on the morale of staff was variable across the teams. Staffing was challenging and feedback from staff was worse in some teams more than others, which contributed toward staff leaving due to the changes.

People received safe, effective and person-centred care as the provider recognised and met the wellbeing needs of staff. These included the necessary resource and facilities for safe working, such as regular breaks and rest areas. The Trust had a lone worker policy, which was adapted to individual teams. Staff were generally aware of the lone worker policy and made arrangements within their local teams. However, staff did not consistently identify clear processes to support safe lone working.