Chief Inspector of Hospitals rates Calderstones Partnership NHS Foundation Trust as Good

England's Chief Inspector of Hospitals has found that Calderstones Partnership NHS Foundation Trust has made significant improvements to the care and treatment of patients following its latest comprehensive inspection by the Care Quality Commission.

Calderstones Partnership NHS Foundation Trust has been rated as Good for providing services that were caring, effective, responsive, safe and well-led.

Full reports of the inspection in October 2015, including ratings for all core services are available on this website.

Calderstones Partnership NHS Foundation Trust provides specialist and forensic learning disability services to approximately 6.6 million individuals across the North of England, as well as Scotland and Northern Ireland, the majority of whom present with extremes of challenging or offending behaviour.

CQC last inspected Calderstones Partnership NHS Foundation Trust as part of its inspection programme in July 2014. This most recent visit was the second comprehensive inspection of the trust and was also planned to assess if the trust had addressed the areas where breaches of regulation had been identified.

Since the first comprehensive inspection in July 2014, the trust had made significant improvements in care and treatment. Following the initial inspection, the trust developed a comprehensive action plan and worked with external stakeholders to address the issues raised. The most significant improvements are the reduction in the number of episodes of restraint, seclusion, and the use of rapid tranquillisation, and the eradication of the use of emergency response belts within the trust.

Dr Paul Lelliott, the Deputy Chief Inspector of Hospitals (and CQC lead for mental health), said:

“Since our first comprehensive inspection in July 2014, the trust has implemented a new model of working called ‘safe wards’ which focusses on reducing restrictive practices and improving patient outcomes. The new model has significantly changed the culture within the trust and enabled staff to work collaboratively with patients and reduce the need to use physical interventions to manage behaviour that staff find challenging. I commend the trust’s efforts in reducing the number of instances of restraint, seclusion, and the use of rapid tranquillisation.

“The trust’s executive team has shown real leadership. It has greatly strengthened the way in which they assure the quality of the work of the clinical staff at Calderstones. They are now able to better identify and manage problems as they arise.

“All of this has been achieved despite the uncertainty regarding the future of the service with the Trust dealing with the challenging staffing issues affecting learning disability nursing nationally. Despite this we were satisfied that there were enough staff to deliver the care and treatment that patients needed.”

“I am pleased to report that all staff had been trained in the new way of working. It is clear that the trust had made major changes that are producing real improvements to the care they provide.”

The inspection team found several areas of good practice, including:

• Within the learning disability service, there were some outstanding examples of staff adapting their interactions with patients based on their individual needs. The staff accepted and embraced the unique communication methods of patients who did not use speech to communicate, including individual sounds and gestures.
• The trust had been leading a national piece of work on behalf of the National Offender Management Service to improve outcomes for offenders with leaning disability.
• The seclusion rooms all had a pictorial sign showing the rights of an individual who had been secluded. Staff were able to play relaxing music through the intercom to patients if they had identified this in their care plan as something that may help them to de-escalate.

During the inspection, CQC did identify some inconsistencies across services in relation to staff training, supervision, de-briefs and staff understanding around the Mental Capacity Act. Inspectors did note that a number of staff trained in basic life skills was low within the learning disability services which could expose patients to a preventable risk within these services.

The Care Quality Commission will present its findings to a local quality summit later this month, including NHS commissioners, providers, regulators and other public bodies. The purpose of the quality summit is to develop a plan of action and recommendations based on the inspection team's findings.

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