Cheshire and Wirral Partnership NHS Foundation Trust

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

We assessed a total of 3 quality statements in the effective 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. Patients had a needs based assessment and could choose to have a copy of their care plan. Patients were aware of what their plan of care was while receiving care and treatment, which included accessible information on what the service provided. Information included contact details for other third sector organisations (voluntary/charities/private ) for support including crisis cafes and respite beds commissioned by the Trust. Carers were provided with information on who to contact should their spouse or family member need help. Assessments and care records included patients and families and demonstrated multidisciplinary working. Crisis teams’ guidance was based on national guidance from the Royal College of Psychiatrists and National Institute for Health and Care Excellence.

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 were involved in the assessment of their needs, and support is provided where needed to maximise their involvement. All patients had a needs based assessment and could chose to have a copy of their care plan. People’s communication needs were assessed and met to maximise the effectiveness of their care and treatment. Patients were generally aware of what their plan of care was while receiving care and treatment, which included accessible information on what the service provided. Information included contact details for other third sector organisations (voluntary/charities/private ) for support, including crisis cafes and respite beds commissioned by the Trust. The needs of carers of people using services were also assessed and met. This supported their health and wellbeing in their carer roles and helped them to provide safe and effective care to the people they support. Carers were also provided with information on who to contact should their spouse or family member need help. Carers were up to date with their spouse or family membe's care and plans to support them moving forward. Carers were given options and choices about what support they needed, where relevant.

People’s needs were assessed using a range of assessment tools to ensure their needs were reflected and understood. All patients had an initial assessment, and staff used a range of assessment tools for the different elements of people's care and treatment. The home treatment team completed a gatekeeping assessment. The first responder completed a triage assessment. Standard tools were used, but all followed a person centred approach. Care plans were offered to patients or shared verbally. Written information included emergency contact details. Assessments considered the person’s health, care, wellbeing, and communication needs, to enable them to receive care or treatment that had the best possible outcomes. Assessment included accessibility or communication needs. Patients had access to interpreters, including British sign language and on the Wirral a multi-cultural centre. If a person had specific mobility needs, then meetings could take place at suitable accessible venues of a patient's choice. People’s care needs were routinely reviewed and could be referred to other services once their initial period of crisis was manageable. For example, patients could be referred to local substance misuse and alcohol services. General practitioners were part of the crisis pathway and provided with information following patient reviews.

People’s needs were assessed using a range of assessment tools to ensure their needs were reflected and understood. Care records showed that patients had comprehensive assessments of their needs. Assessments were biopsychosocial and the Trust used the 5Ps as a risk assessment tool (Presenting problem, Predisposing factors, Precipitating factors, Perpetuating factors, and Protective factors.). Risk assessment were included at each stage of assessment and the care planning process from the crisis line, liaison psychiatry and home treatment teams. All assessments and care plans were recorded on the Trust electronic patient system and copied to the acute hospital system for liaison psychiatry interactions. Some teams, for example the crisis line and liaison psychiatry had some different templates, (Liaison psychiatry used a side by side assessment process in the acute trust) so information was shared across the crisis care pathway. Care plans were variable, in terms of recording and were not always documented in the care plan section of the Trust patient electronic records. However a plan of care was documented, usually in the progress notes. People's plans had a standardised format for recording information, but where personalised to the patient's needs, as well as recording multidisciplinary working, when different teams were involved in a patient's care.

People were told about current good practice that is relevant to their care and are involved in how this is reflected in their care plan. We did not receive direct feedback about delivering evidence-based care and treatment from patients or carers. However, assessment and care records content showed that patients had access to crisis services and were referred to or signposted to alternatives to hospital admission.

People received care, treatment and support that was evidence-based and in line with good practice standards. Staff were still implementing the changes made to the model of care provided by the service. Staff provided feedback on how the changes had been implemented and some were more positive than others about the potential benefits of the changes. It was clear that guidance was still developing to support new ways of working.

Staff and leaders were encouraged to learn about new and innovative approaches that evidence showed could improve the way their service delivers care. The provider’s systems ensured that staff were up to date with national legislation, evidence-based good practice and required standards. The trust followed the Royal College of Psychiatrists' guidance on crisis teams and delivered a core 24 hour service. The Trust had commenced using the model of self-defined crisis. People had access to crisis cafes and crisis beds and other third sector services, which were less restrictive than hospital admission. Carers were referred for a carers assessment. Patients received a comprehensive risk assessment and physical health screening. The Core24 model included a full multidisciplinary team, however, we were aware the Trust were still recruiting to specific vacancies within the teams which made up the crisis service. The new model of care followed national guidance on ‘self-defined crisis’ so there was no exclusion criteria. However, staff said this had impacted on the services and more people were seen who did not have primary/ or secondary mental illness. Side by side assessments were completed by liaison psychiatry to avoid patients having to wait hours to be discharged by medical staff. Physical health care was included as part of assessments and some teams had dedicated staff for this. Pharmacists were employed within the home treatment teams to provide advice and support directly to patients and staff. The first response model had also been commenced with Cheshire police and street triage team.

When people received care from a range of different staff, teams, or services, it was co-ordinated effectively. People moved between services, which included liaison psychiatry, home treatment and community mental health teams for longer term care. Patients were aware of the arrangements on how to access crisis line, crisis cafés and other community support. Carers were also aware of these services.

The 'first response’ model was still embedding across the crisis services and crisis line remained as the point of contact for patients to access services. Patients could be assessed in emergency departments by liaison psychiatry staff, supported by home treatment teams or referred onto community mental health teams for longer term support. Staff said teams worked well with liaison psychiatry in the accident and emergency departments working together with acute trust staff, completing side by side assessments and liaison psychiatry completing initial assessment within 30-60 mins of a patient’s arrival in accident and emergency. Further mental health assessment or support was available to liaison psychiatry if patients required assessment under the Mental Health Act. In addition patients could be referred onto third sector organisations (voluntary/charities/private ) for support, including crisis cafes and respite beds commissioned by the Trust. Trust staff worked with Cheshire police and Merseyside police and dstreet triage was implemented differently across the Trust geographical footprint. At the time of the inspection the Trust had introduce a joint service with the local NHS ambulance service. The first responder role was still embedding across the trust. This role allowed first responders to support teams when referral and assessment activity increased and could work across the crisis pathway. Trust managers and staff linked in with contracted third sector providers to make sure they participated in providing feedback on how the two sectors worked together to improve the offer to patients. General practitioners and the police could contact the crisis line for advice and support.

Information was shared between teams and services to ensure continuity of care, for example, when clinical tasks were delegated or when people were referred between services. We observed positive meetings where staff discussed patient flow between teams, with evidence of joint working, with staff in accident and emergency departments and on call general practitioners. All Trust staff had access to care records through the electronic patient records system. Liaison psychiatry had access to electronic care record system provided by acute trust in accident and emergency department. The Trust was linked into the NHS 111 mental health system.

When people received care from a range of different staff teams, or services, it was co-ordinated effectively. All relevant staff teams and services participated in assessing, planning and delivering people's care and treatment. Staff work collaboratively to understand and meet people's needs. Care records showed joint working between teams and when patients moved between services information was available through the trust patient records system. Liaison psychiatry had access to the acute trust records and information was shared between the acute and mental health trusts. There was a crisis treatment pathway which included all the crisis services. The introduction of the first response team was aimed at the reduction of multiple assessment of patients when only one assessment of a patient was required for all crisis services.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Monitoring and improving outcomes during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Consent to care and treatment during this assessment. The score for this quality statement is based on the previous rating for Effective.