10/03/2020 - 12/03/2020
During an inspection of Long stay or rehabilitation mental health wards for working age adults
Our rating of this service stayed the same. We rated it as good because:
This is an organisation that runs the health and social care services we inspect
Our rating of this service stayed the same. We rated it as good because:
We have not updated trust-level ratings following this core service inspection because we were not able to complete the trust-level well-led inspection. This is due to suspension of routine inspections during the COVID-19 pandemic. Refer to the previous inspection report for the detailed findings on which the ratings are based.
However:
The summary for this service appears in the overall summary of this report.
The summary for this service appears in the overall summary of this report.
The summary for this service appears in the overall summary of this report.
We rated community mental health services for people with learning disabilities or autism as requires improvement because:
However:
Multi-disciplinary team working was an integral part of all the teams and supported patients and staff effectively, through regular referral meetings and multi-disciplinary case discussions. Teams communicated effectively and understood their role.
There was rapid access to a psychiatrist when needed.
The teams had effective lone-working policies and followed them.
Staff monitored waiting lists and patients and their carers could contact staff if their condition deteriorated.
Staff reported incidents on the trust’s electronic recording system. Staff investigated incidents when necessary and lessons learned were shared within teams. Staff knew how to recognise abuse and make safeguarding referrals to the local authority.
Staff were passionate about getting the best possible outcome for the patients they worked with and about providing them with high quality care.
Staff knew their patients well and could demonstrate an understanding of their needs. Teams spoke about patients in a person centred way.
Staff encouraged patients and their families to feed back about the service and that feedback was very positive.
When aggregating ratings, our inspection teams follow a set of principles to ensure consistent decisions. The principles will normally apply but will be balanced by inspection teams using their discretion and professional judgement in the light of all of the available evidence.
We rated the trust overall as good because:
The trust had responded in a positive way to the improvements we asked them to make following their last inspection. Improvements in most core services were noted across the trust.
Patient care environments were clean, in good decorative order and appropriately furnished. Services had sufficient rooms for the safe care and treatment of patients, including private areas for patients to receive 1-1 support from staff or see visitors. All inpatient services had activities programmes for patients. There was access to activities over a seven day period. Each ward had timetables visible so that patients knew what was on offer. Patients could personalise their bedrooms and had lockable storage for their possessions. The trust was meeting Department of Health guidance for eliminating mixed sex accommodation.
The trust had made significant improvements to the external courtyards on the adult acute wards since our last inspection. For example, installation of closed circuit television and two way intercom systems and removal of ligature risks. Works were still on-going. In the inpatient ward for children and young people, innovative observation panels were fitted on bedroom doors, which had privacy frosting on them that was removed electronically when staff pressed a button.
The trust was opening a psychiatric intensive care unit for males in the summer of 2017 and had plans to provide a psychiatric high dependency unit provision for females.
The trust had reviewed its management of ligature risks within services. Staff were aware of the risks in their environments and ligature assessments were re-assessed regularly. On inpatient wards, staff had quick access to ‘heat maps’, specific to their area, to assist in the safe management of patients presenting with high risk of self harm or suicide.
Throughout the trust, staff treated patients with kindness, dignity and respect. Consistently, staff attitudes were helpful and understanding. Staff used kind and supportive language that patients would understand. Staff encouraged patients to give feedback about their care in a variety of ways. Information leaflets were available in easy read formats and we saw evidence of a variety of information available to patients, for example on how to access interpreters, make complaints, access to advocacy and Mental Health Act information.
The trust employed suitably qualified and experienced staff to deliver safe care and treatment to patients and provided them with training and development opportunities. The trust had supported healthcare support workers to undertake training to become registered nurses, provided a robust induction programme and supported clinical apprenticeship to encourage young people to seek employment with the organisation. The trust utilised a values based recruitment checklist during their interview process and revisited this during staff induction. The trust also operated a rewards and recognition system, including individual and team recognition, thank you cards, hero’s awards and annual awards ceremonies.
Managers ensured staffing levels across all core services were planned and regularly reviewed. The majority of services across the trust increased staffing based on clinical need and made arrangements to cover leave, sickness and absence. Local managers had authority to make these decisions. The trust employed bank or agency staff to fill vacancies. Where possible, managers ensured temporary staff were familiar with the patients and teams in which they worked. This ensured continuity of care for patients. Bank staff received appropriate training for their roles.
Staff received mandatory and role specific training. As at 31 March 2017, the overall compliance across all core services was 92%. Staff had access to additional specialist training, relevant to their role and medical staff had protected time for training and development.
Staff received an annual appraisal. As at 31 March 2017, 92% staff were compliant.
The trust reported a reduction in staff sickness rates. In December 2015, staff sickness was reported as 5.1%. In February 2017, this had reduced to 4.5% as a 12-month average.
The trust regularly reviewed caseloads for staff working in community teams. Where caseloads were high, staff were able to explain the rationale for this.
Crisis teams were meeting commissioned targets for contacting patients within four hours. As of February 2017, 99% of patients were contacted within this time. Crisis teams had good working relationships with the local Police
The trust had a robust governance structure in place to manage, review and give feedback from complaints. Staff consistently knew how to handle complaints, and managers investigated complaints promptly Patients and carers received timely responses and outcomes.
The trust had safeguarding policies and robust safeguarding reporting systems in place and described how they worked with partner agencies to protect vulnerable adults and children.
The trust used an electronic system for reporting incidents. Trust staff knew what incidents needed to be reported and how to report them. Managers monitored the reporting and recording of incidents. The trust had robust systems for sharing lessons learned from incidents. We saw evidence of compliance with duty of candour guidance related to investigations from serious incidents and complaints. Patients, families and carers were fully involved and informed throughout all processes. The trust board encouraged candour, openness and honesty from staff. Staff knew how to whistle-blow and staff felt able to raise concerns without fear of victimisation.
The trust had robust process to monitor the fitness of senior staff to work within the service, under the principles of fit and proper persons requirements.
Senior managers told us there had been much organisational change and transformation of care within the trust. Staff told us they accepted change and positively embraced the opportunity it provided. They felt supported by the board to work with change and felt able to provide feedback about their experiences. Overall, we found significant improvement to staff morale across most teams.
The trust had robust systems in place to manage the prescribing, storage and administration of medication. We found good working practices between the pharmacy team and staff across all services.
Overall, we saw good multidisciplinary working and generally patients’ needs, including physical health needs, were assessed and care and treatment was planned to meet them.
Staff had a process in place to submit concerns and issues to the local risk registers which fed in to the trust wide risk register where appropriate.
However:
Whilst there had been significant progress since the last inspection in 2015, the trust had not fully addressed all our previous concerns.
The trust could not always provide a bed locally for patients who required admission to adult acute mental health beds. This meant that patients often received care and treatment outside of the trust. Between March 2016 and March 2017, there were 306 out of area placements from the trust to other providers of acute adult inpatient care. The trust did not have psychiatric intensive care unit (PICU) beds. Therefore, if a PICU bed was required, patients were placed out of area. Between February 2016 and February 2017, 63 patients were transferred to other providers when intensive care was required.
Bed occupancy rates were above 100% on the adult acute wards. We saw that patient numbers exceeded the number of beds available on wards. Therefore, there were no beds available if patients returned from leave.
The majority of beds within the adult acute admission wards were located in bays sleeping either four or five patients. These areas offered limited space and privacy.
Within the forensic inpatient secure ward we found patients did not have free access to the garden. This was a blanket restriction. We were also concerned about the safety of the security fencing in the garden area. We raised this with the trust who made immediate plans to have this replaced.
In the inpatient ward for children and young people, most doors on the ward were locked, this included bedrooms, toilets and bathrooms, dining room, the female only lounge and doors to the garden. There was no clinical justification for this practice and it was not individually care planned. This was a blanket restriction. We raised these concerns with senior managers and when we returned on 20 April, the trust had taken action to ensure patients were provided with wrist bands, programmed to allow access to specified areas.
The trust had identified they need to take further actions to ensure the health based place of safety fully met the Royal College of Psychiatrist standards.
Not all patients had timely access to psychological therapies as recommended by the National Institute for Health and Care Excellence.
Information from April 2016 to March 2017 showed 242 patients were discharged from the health based place of safety within 72 hours. On 127 occasions, staff had not completed the patient’s discharge time on records.
The trust provided data for staff compliance with clinical supervision; however, this showed significant variance in compliance across teams. The trust told us they had introduced a new method of recording supervision, which was not yet fully embedded. Clinical and managerial supervision data was not collected separately. However, data provided showed overall compliance with clinical supervision across all core services ranged from 7% in October 2016 to 88% in March 2017, with an overall average compliance across all core services of 48%, against the trust target of 95%. From data provided and on site findings, we were unable to determine how supervision was delivered, for example how often staff received one to one support, or whether managerial supervision was provided in accordance with the trust policy. It was equally unclear how outcomes from staff supervision were reviewed or acted upon. We were not, therefore, assured the trust had clear oversight of compliance with management supervision. The trust could not be sure that all performance issues, training requirements or professional development had been identified for staff working in the service.
Not all staff had completed mandatory training in line with the trust target. For example, on the acute wards for adults only 58% of staff had completed safeguarding children level 3 training. We were concerned that only 63% of staff were compliant with basic life support training, meaning they might not have the required or up to date skills to support patients in an emergency. Equally, only 61% had completed conflict resolution (restraint) training, meaning they might not have the required or up to date skills to safely manage patients requiring physical interventions.
The trust policy on the management of violence and aggression did not contain guidance from the Mental Capacity Act relating to the use of prone restraint and did not reference up to date National Institute for Health and Care Excellence guidelines. We found an increase since our last inspection in both incidents of restraint and the use of prone (face down) restraint.
We found some errors on community treatment order paperwork. Seclusion paperwork did not always meet the guidance in the Mental Health Act Code of Practice and medical assessments were not always fully completed or recorded. Staff did not complete seclusion care plans for patients nursed in seclusion on the adult acute wards.
We rated child and adolescent mental health wards as good because:
The ward was clean, tidy and well maintained. Observation mirrors and closed circuit television was used to assist nursing staff with observations.
The ward had an up to date ligature risk audit, staff mitigated the risk on the ward by observing patients. Staff mitigated the risks posed in the garden area by accompanying patients when they wanted to access the garden.
The ward had sufficient staff to provide good care and treatment to patients.
The ward met the criteria for eliminated mixed sex accommodation in line with guidance contained in the Mental Health Act code of practice.
Staff were 98% compliant for mandatory training.
Staff undertook a risk assessment with every patient upon admission. Care plans were comprehensive, personalised, holistic, and recovery orientated.
Staff provided a range of therapeutic interventions in line with the National Institute for Health and Care Excellence guidelines and there was a full education programme in place.
Staff read detained patients their rights on admission and regularly thereafter. Staff gave patients an information leaflet explaining their rights and responsibilities as an informal patient.
Overall, 100% of non-medical staff had an up to date appraisal.
There was a well-functioning multidisciplinary team. Staff discussed patients’ care and treatment weekly in ward round. Parents told us that they felt involved in the care and treatment.
Patients told us that they felt supported to make their own decisions and staff treated them with dignity and respect. Patients said they were involved in their care plan.
Staff interacted with patients in a positive way. All staff demonstrated a good understanding of patients’ individual needs, including care plans, observations and risks.
The ward had a range of rooms and equipment to support treatment and care. There was a large garden; with an area that had been made secure. Patients could personalise their bedrooms and could choose from a choice of bedding.
There was a family room for parents, carers and siblings to visit. Visits within the community and the garden area were also encouraged.
There was access to activity across the week with primarily nurse led sessions over the weekend. Patients worked with the activity coordinator to plan activities that they would like to do.
All staff demonstrated the trust values in their behaviour and attitude. Staff we spoke with were passionate about helping patients with mental illness. Staff were proud of the work that they carried out and the care that they provided to patients.
Managers told us they had sufficient authority to complete their role and they felt supported by senior managers.
However:
Staff kept most doors on the ward locked. There was no clinical justification for this practice and it was not individually care planned. This was a blanket restriction.
Seventy-one per cent of staff had undertaken training in clinical risk assessment and management. This was below the trust target of 95%.
We rated Lincolnshire Partnership NHS Foundation Trust specialist community mental health services for children and patients as outstanding because:
Patients and carers told us that everyone was caring, compassionate, kind and treated them in a respectful manner. All feedback surveys collected by the trust were consistently positive about the way that staff treated patients.
The service had established an innovative model of working using outcome measures at each appointment. This model was patient centred and holistic based around the child or young persons’ strengths and goals.
Staff were open and transparent in relation to incidents and complaints. They acted on lesson learnt from incidents and complaints. They strived to continually improve the service they delivered by working closely with commissioners and other stakeholders.
Managers and senior staff including board members were visible and approachable. Staff expressed they felt able to raise concerns without fear of reprisal. The managers and team co-ordinators were passionate about delivering high quality care and treatment and had funded 17 clinicians to undertake children and young people’s improving access to psychological therapies training. They had managed to recruit to the 17 vacancies with substantive posts therefore increasing the level of staffing within the service.
Risk assessments and care plans were comprehensive and well written. They were developed in collaboration with the patient and, where appropriate, their carers. Staff were able to refer patients to the crisis and home treatment and resolution service within CAMHS if they were concerned about a young person’s presentation out of hours and at weekends. This service had been praised highly by senior staff at the local hospitals in relation to the responsiveness of the team Communication between the teams was excellent.
The service had introduced an animal assisted therapy service to group work for patients.
However:
Only 68% of staff had undertaken the children’s safeguarding training level 3B.This was below the trust target of 95%.
Staff supervision rates were lower than the trust expectations and managers did not always keep a record of supervision sessions.
We rated mental health crisis services and health-based places of safety as ‘good ‘because:
However
However:
We rated community based community mental health services for older people as good because:
All patient information was stored electronically and was accessible to staff.
The service followed National Institute for Health and Care and Excellence (NICE) guidance in prescribing medication and reviewing patients who had dementia.
Patients were consistently positive about the centres and about the staff, patients felt understood and cared for.
Patients told us that they felt involved in their care planning and that they had been offered a copy of their care plan.
Staff were able to prioritise and see urgent referrals quickly.
There was a safeguarding champion available to support staff with safeguarding concerns and safeguarding posters were displayed in the reception areas at each of the locations.
Staff learned from incidents, complaints and patient feedback via the bi monthly lessons learned bulletin, at team meetings and during supervision. We saw examples of lessons learned and changes in practice as a result of this.
Leaflets were available in different languages and information was available in different formats on request.
Staff were passionate about their jobs and used the trusts’ vision and values in their everyday work.
Senior managers were visible and known to staff. They visited the locations to update staff on changes within the service and the trust.
Sickness and absence rates were low and clear strategies were in place to cover any staffing shortfalls.
We rated acute wards for adults of working age as requires improvement because:
However:
We rated Long stay/r ehabilitation on mental health wards for working age adults as good because:
All wards had detailed ligature risk assessments. Staff knew where the risks were and how they should manage them. Patients said they felt safe on the ward.
The majority (94%) of staff had received training in safeguarding adults and were able to identify what abuse was.
Staff used a range of tools to measure patient outcomes. These included the recovery star, depression ratings, clustering and national early warning scores.
Morale within all teams was high. Staff worked well together within a multi-disciplinary approach.
Managers carried out audits of their ward performance, care records and safeguarding.
The service had participated in the Accreditation for Inpatient Mental Health Service (AIMS). All wards had been accredited as excellent up to October 2017 when the review was due.
However:
At the time of our visit, Vale ward reported a vacancy rate for qualified staff of 15%. The manager advised she had raised this as a risk issue and had put forward a proposal to block book regular agency staff to keep staffing levels safe.
Staff raised concerns at Maple Lodge about medical cover not being sufficient.
Supervision rates were slightly below the trust target of eight supervisions a year in two of the five wards.
On two wards food fridge temperatures were above the acceptable range.
We rated community based mental health services for working age adults as requires improvement because:
Care plans were not always personalised, holistic or recovery focussed.
Regular medication reviews and physical healthcare monitoring for patients did not take place consistently.
The trust did not use any formal outcome measures to assess patient progress.
Individual patient’s risk assessments were not reviewed consistently.
We identified errors and omissions in Community Treatment Orders and this documentation was not fully audited by the trust.
The service did not have an effective governance system. The balanced scorecard used to gauge the performance of the team was inaccurate and not shared with front line staff.
Managers did not have an effective audit system in place to audit Mental Health Act paperwork.
The trust had not proactively addressed the long waits for psychological therapies by some patients.
There was no local risk register.
However:
All teams had safe staffing levels, and ensured sufficient care co-ordination time for all patients.
Patients had a thorough risk assessment completed at their initial assessment.
Teams had good multi-disciplinary and interagency working, with close links to other teams within the trust and the local community.
We rated forensic inpatient/ secure units as good overall because:
Francis Willis was a slightly dated but pleasant environment. There were clear lines of sight throughout the ward. The trust has completed detailed ligature risk assessments and plans were in place to appropriately manage these risks within the unit.
The defibrillator and essential safety equipment had been serviced and regular checks were undertaken.
There was sufficient staffing during weekdays and the unit had medical support at all times. Staff had undertaken mandatory training and received regular supervision and appraisal
Nursing staff on the wards were enthusiastic in their approach and patients spoke positively about them. The clinical team contained full multi-disciplinary representation.
All admissions were planned following pre admission assessments. Local risk assessments were also carried out after admission. Patient care plans were personalised and based around the individualised risk.
All patients had their physical healthcare needs met and there was an effective health care recording system
Leadership on the unit was highly visible and managers had a positive presence on the ward.
Areas of concern highlighted following our previous inspection had been addressed.
However:
We remain concerned about the safety of the garden area of the ward. This contained potential ligature points and additional safety risks that had not been addressed through environmental risk management plans. Staff managed these risks through restricting patient access.
We found some other examples of blanket restrictions. These included access to mobile phones and set vaping times.
While patients had a good level of activity and escorted leave during weekdays there were limited activities available at weekend.
When aggregating ratings, our inspection teams follow a set of principles to ensure consistent decisions. The principles will normally apply but will be balanced by inspection teams using their discretion and professional judgement in the light of all of the available evidence.
We rated Lincolnshire Partnership NHS Foundation Trust as Requires Improvement overall because:
However:
We rated Lincolnshire Partnership NHS Foundation Trust child and adolescent mental health wards as requires improvement because:
However:
We gave an overall rating for mental health crisis services and health-based places of safety as requires improvement because:
However:
We rated Lincolnshire Partnership Foundation NHS Trust community mental health services for people with learning disability or autism as good because:
Risk assessments were completed, with patients being encouraged to identify their own risk management plans.
Staffing levels were good within the service. Patients had regular access to staff for support.
Staff received regular supervision and appraisal from the management team. The team had a variety of skills, experience and professional training. Patients were able to access support from people with a variety of skills and expertise.
Staff were passionate and enthusiastic about the difference they could make to service users and carers lives.
There were good working relationships with other agencies, such as social services.
The service offered appointments to patients at a variety of different times and locations to facilitate attendance at appointments.
Service user feedback forms showed multiple positive comments.
Complaints had been investigated and acted upon quickly and there were good systems in place to share learning from complaints throughout the service.
All of the Learning Disability Community Mental Health Team bases had adequate clinic rooms, and, or interview rooms and most areas were clean and well maintained.
However:
There were two electronic record systems in operation within the community learning disability teams that did not interface with each other. Important information could be missed.
Care plan wording was not recovery focussed.
The speech and language therapy service was struggling to meet its referral to assessment targets of two weeks for urgent referrals and 18 weeks for routine referrals. There were 53 patients on the waiting list, five of whom had breached the 18 week target. The service was only able to offer urgent dysphagia assessment two days per week.
Some community services did not display easy to read documentation for patients with a learning disability.
We rated this core service as ‘good’ because:
However:
We rated Lincolnshire Partnership NHS Foundation Trust specialist community mental health services for children and young people as outstanding because:
Young people and carers told us that everyone was caring, friendly, compassionate and positive with them. All feedback including surveys collected by the trust was consistently positive about the way staff treat people. Other agencies said that there was a visible child centred culture within the teams. Staff consistently worked to empower young people to have a voice in their care.
Staff were positive and enthusiastic about their roles in the service. Staff were committed to the young people and demonstrated an in-depth knowledge of their circumstances and empathy. All staff, both clinical and non-clinical, displayed a passion to meet young people’s needs.Morale in the service was very high with low sickness and vacancy rates.
Managers and leaders were passionate about the service, their staff and the care of young people.They were respected and appreciated by staff who said they were very supportive. There was good development and support for managers and future leaders were identified and nurtured.
The service was actively involved in research and developing areas of best practice. Staff within the trust had developed “outcomes oriented child and adolescent mental health service”. This evidence based model focussed on the outcomes for young people and had been recognised in NHS innovation awards. This demonstrated clear positive outcomes for young people using the service. Other CAMHS services were adopting this model.
Access times were short for young people with mental health problems. There was good crisis provision with plans to expand this into home treatment assertive outreach teams.
Incidents and complaints were well managed with good duty of candour.There was clear learning and actions taken.
Psychological therapies in line with NICE guidance were evident including consideration of appropriate interventions when reviewing referrals. There were comprehensive clear treatment pathways in both services. There was innovation in how to meet individual young people’s needs with the service being responsive and creating new interventions tailored to them.
Comprehensive assessments were completed and care records, were up to date, considered the young person’s needs with clear recovery-orientated care plans. Risk assessments were of a good standard with very good crisis plans.
Other agencies described excellent relationships and partnership working.Social workers and school staff described good outcomes for young people who had used the service.
However:
Young people with learning disabilities in Lincolnshire had delays of up to eight months in accessing a service.
Staff and managers in Lincolnshire felt disconnected and uncertain about the service redesign and more could be done to communicate the changes and vision to them by the trust and commissioners.
Safeguarding training compliance was lower than expected due to the trust using local authority safeguarding board training in line with recommended practice. The safeguarding board was not providing sufficient training to meet the service’s needs. Despite this staff displayed excellent safeguarding knowledge.
We rated this core service overall as ‘requires improvement’ because:
Staff vacancies and sickness impacted on their ability to deliver a service.
Some risk assessments and care plans were basic and review dates were not always recorded.
Some health and safety checks were not always completed.
The ICMHTs had not been routinely involved in the development serious investigation action plans and staff had difficulty relating the learning from incidents to their work.
Records did not show that patients received regular physical healthcare examinations.
Teams were not always meeting trust targets for staff training, supervision and appraisals.
Records did not show that patients had their rights regularly explained to them when subject to a community treatment order.
There were delays with staff providing timely patient assessments and treatment.
Staff told us they had not received adequate communication from the trust regarding restructuring and changes to the service.
Staff were not aware of any action plans to address areas of poor performance identified following a national Care Quality Commission CMHT survey.
However:
Staff were aware of their individual responsibility in identifying any safeguarding concerns.
We observed effective patient assessments and reviews, with staff gaining the patients’ history, current needs and risks.
Staff treated patients with respect.
Patients and carers told us that staff supported them with their individual needs.
Staff were proud of their work with patients, despite the challenges they had with staffing resources.
Teams prioritised urgent referrals and worked closely with crisis teams.
A ‘heat map’ and identified service risks.
Teams had staff champions leading on specific areas to improve the quality of service.
Staff told us their line managers were approachable and supportive.
We rated inpatient rehabilitation wards as requires improvement overall because:
However:
Overall we rated wards for older people with mental health problems as requires improvement because:
However:
We rated forensic inpatient/secure units as good overall because:
However:
We rated acute wards for adults of working age and psychiatric intensive care units as ‘requires improvement’ because:
There were features of the ward environment that were unsafe.We identified potential ligature anchor points that had not been included in the trust's ligature risk audits. The trust had identified other ligature risks but in some areas had no plans in place to manage patient safety. The seclusion room on Ward 12 contained ligature points in the toilet facilities. Staff could not observe patients in this area and entered the room to ensure patient safety. This was a risk to both patients and staff. There were further ligature points in patient bedroom areas and anti-ligature wardrobes had not been secured to walls. There were also ligature points in the courtyards. The floor of one courtyard was uneven.There was no nurse call system for patients to summon assistance if needed.We reported our findings to the trust.At the time of the follow-up inspection, the trust was making plans to take action to rectify these issues.
Most beds were situated in bays. Some patients told us they did not feel safe and these areas lacked privacy.
Bed occupancy rates were often over 100%. This meant that staff needed to use leave beds for new admissions.
We found different protocols and working practices in operation across the acute wards. This also meant that some informal and detained patients had restricted access to fresh air at night.
Some Mental Health Act (MHA) paperwork used to record patient’s rights was out of date and MHA patient leave forms lacked clarity.
Compliance with mandatory training was below the trust’s own target. Compliance with Mental Capacity Act and MHA training was particularly low with 35% and 66% of staff having been trained respectively. The trust could not be sure that staff had received appropriate training for their role.
Staff did not always receive supervision in a timely manner. The trust could not be sure that professional and developmental issues were discussed with staff.
The trust had no psychiatric intensive care (PICU) beds. Staff told us there were often delays in transferring patients to suitable PICU beds. The trust had plans to provide PICU facilities in the near future.
Patients told us the food was of good quality however, there was no hot meal in the evening. Patients told us they disliked having sandwiches every evening. This did not meet the recommendations of the Hospital Food Standards Panel.
However:
Wards were clean and had ample rooms for activities and patient visits. The trust provided activities on all wards, including at weekends.
Patients had individualised risk assessments, with plans in place to manage risks. Care plans were comprehensive and holistic, and addressed a full range of needs and problems.
Patients received regular monitoring of their physical healthcare needs.
Clinical nurse leads undertook relevant audits and there was good evidence of effective multi-disciplinary team working. There were good medicines management processes and clinic rooms were clean and tidy. Good systems were in place for reporting and recording incidents and complaints.
Staff were professional and respectful. Most patients told us staff were caring. Staff showed a good understanding of the care and treatment needs of patients and we observed good interactions between patients and staff.
All three wards had achieved accreditation under the Royal College of Psychiatrists AIMS standards.
We rated Lincolnshire Partnership Foundation NHS Trust substance misuse services as requires improvement because:
However:
Our findings at The Francis Willis unit were:
Risk assessments and management plans were available for patients and a current ligature audit risk assessment was seen. A local risk register was in place and this was used to identify any wider trust learning from incidents. These had been investigated appropriately and any lessons learnt had been shared through the trust’s reporting systems. This meant that the trust had taken steps to ensure the safety of patients and others.
Staff received additional role specific training. For example, forensic services, substance misuse and reinforce the appropriate and implode the disruptive (RAID) training had been provided for front line staff. Different professions worked effectively to assess and plan care and treatment programmes for patients.
Patients were positive about the support which they received on the unit. We saw good examples of effective staff and patient interaction and individual support being provided.
Clear assessments were in place to ensure that the unit’s admission criteria were being met. The trust reported responsive joint working with the commissioners of this service. Each patient had a weekly occupational therapy programme. Evidence was seen of monitoring arrangements to ensure that patients were offered at least 25 hours of activity per week.
Staff reported positive morale and good peer support. The unit was a member of the Royal College of Psychiatrist’s quality network for forensic mental health services. The last review had taken place in March 2013.
But we also found:
Our findings at the Peter Hodgkinson Centre were:
Patients told us that they usually felt safe on the unit. Staff reported incidents/accidents and there was a system in place for reviewing and learning from them to prevent a reoccurrence. Systems were in place to ensure adequate staffing levels and appropriate skill mix on both wards to meet the needs of individual patients.
Staff provided a range of therapeutic interventions in line with National Institute of Clinical Excellence (NICE). Regular team meetings took place and staff told us that they felt supported by colleagues. Health care assistants were receiving training in order to obtain the care certificate. Staff reported receiving effective training opportunities.
Patients knew who their primary nurse was and felt able to talk to them. They told us that they felt involved in their individual care and that they met with their doctor regularly.
Clear admission assessments were in place. Patients were being supported to access Section 17 leave supported by staff. We found that patients had discharge plans where appropriate. The average length of stay on this unit was three months.
Staff reported good morale and positive peer support and told us that their line manager was supportive and provided clear guidance. Both wards had the accreditation for in-patients mental health service (AIMS). This is a standards-based accreditation programme designed to improve the quality of care in inpatient mental health wards and is managed by the Royal College of Psychiatrists Centre for Quality improvement.
But we also found:
Each year, we visit all NHS trusts and independent providers who care for people whose rights are restricted under the Mental Health Act to monitor the care they provide and check that patients' rights are met. Immediate concerns raised by patients on those visits are discussed, if appropriate, with hospital staff.
Our Mental Health Act Commissioners may carry out a number of visits to each provider over a 12-month period, during which they talk to detained patients, staff and managers about how services are provided. In the past, we summarised themes from the visits and published an annual statement followed by the provider's response where applicable. We are looking at different ways to indicate the outcomes of our monitoring in the future.