People told us: “I have my medication but I can refuse it if I want to.”

“Staff explain things to me, by talking to them it helps me understand my illness better and how to cope with and without medication.”

Staff involve people in their treatment and give them the information they need so to help them make a choice about what treatment they have.

Staff involve people so to gain consent from them for their treatment. They ensure that treatment given is in the best interests of the person to ensure their health and well being.

People are involved in their care plans and reviews about them if they want to be.

People told us: “It’s alright here, it has its ups and downs but staff are very nice.”

“I have nothing to complain about the staff, they do their jobs.”

“I do my own washing, helps to keep me independent.”

“I have input from doctors, nurses and community nurse.”

“The staff are very pleasant. The food is nice and you get a choice.”

“I am involved in my care plan and see the doctor.”

“Staff are really nice, staff ask about me and how I am, by talking to staff it helps me understand my illness better and how to cope with and without medication.”

On some wards people were unable to communicate with us verbally so we spent time observing them and how staff interacted with them. We saw that staff had good relationships with the people on the ward. Staff were aware of people’s moods and how to communicate with them depending on these.

We saw that people were clean, well presented and were dressed in individual styles.

We saw that planning for discharge started when the person is admitted. Staff said it is the aim to help people recover so they can go home and not to stay in hospital for long periods of time, which can reduce their independence.

Staff had a good knowledge of how to meet people’s individual needs. Staff receive training in how to care for people and this gives them the skills and knowledge to do their job.

There have been improvements in alternative treatments to medication being available such as talking therapies. Staff told us that more of this is needed to improve people’s recovery in the long term and prevent them being readmitted to hospital.

One person said, “I feel safe here.”

We saw staff work with people in a way that diffused their agitation and ensured they and others were safe.

Staff receive training in how to safeguard people from harm and generally showed they had good knowledge of this.

Regular audits are completed so that improvements can be made to the service offered to people.

The views of people who use the service and those who act on their behalf are listened to. Improvements have been made as a result of this.

Clent

Core service provided: Acute admission ward

Male/female/mixed: male

Capacity: 22

Kinver

Core service provided: Acute admission ward

Male/female/mixed: female

Capacity: 20

Wrekin

Core service provided: Acute admission ward

Male/female/mixed: mixed

Capacity: 16 + 2 bed extra care area

Core service provided: Psychiatric Intensive Care Units and health based places of safety

Male/female/mixed: mixed

Capacity:

Holyrood

Core service provided: Older People

Male/female/mixed: mixed

Capacity: 17

Malvern

Core service provided: Older

Male/female/mixed: mixed

Capacity: 22

Bushey Fields Hospital is in Dudley and offers specialist assessment, care and treatment to adults and who are experiencing mental health difficulties. Bushey Fields Hospital has three acute wards – one male ward (Clent), one female ward (Kinver), and an admission ward (Wrekin). It also has two older people’s wards (Holyrood and Malvern).

We found a number of inconsistencies across the different services.

We found that on some wards, staff were not trained to meet the specific needs of the people who use services and this increased the risks to both people using the service and staff.

In the majority of wards there was continuity of care and most staff understood the needs of the people they were caring for. Staff worked with other providers to ensure that transfers and discharges were effective.

There was evidence of good risk assessment taking place and every person’s record we saw had a completed assessment. However, there was not always an associated risk management plan in place to manage the identified risks.

There was a system for staff to report incidents.

Incident reporting was not completed in a consistent manner and we could not see evidence that the results of local audits were analysed and shared quickly enough within the older people’s wards.

On some adult acute wards, we saw examples of learning from audits and incidents being embedded and changes to practice being made as a result.

Some wards were better managed than others and we had concerns about the care environment and treatment on Holyrood ward.

We saw that people were treated with dignity and respect and saw staff and people who use services interacting positively with each other in most wards.

The Mental Health Act responsibilities were discharged appropriately, although actions from previous Mental Health Act monitoring visits were not fully resolved.

Staff were unaware of the future plans for the older people’s service.

We saw evidence that people were nursed in isolation in the extra care areas, were prevented from leaving the extra care area and refused contact with other people.

The staff had not recognised that the practices used in the extra care areas may meet the threshold of seclusion, as defined by the Mental Health Act Code of Practice.

The medicine management team had recently introduced a ‘drop-in’ session to discuss any medicine issues with patients.

There was good collaborative working regarding physical health needs with the general hospital, which is on the same site.

We saw that the health-based place of safety did not meet the recognised environmental standards.

We saw that the older peoples wards were mixed gender and placed people at risk of receiving care that compromised their dignity.