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Provider: Mersey Care NHS Foundation Trust Good

Following a recent review of Learning Disability and Autism Secure Services, the report below was published. We will update the information on this page to reflect this report shortly.

This provider has requested a review of one or more of the ratings.

Reports


Inspection carried out on 20 March 2017 to 23 March 2017

During a routine inspection

We rated the trust as good overall because:

  • The trust’s restrictive practice reduction programme was effective. There was a clear commitment to safeguarding. Almost all of the individual patient risk assessments we reviewed were thorough and up to date. The trust was compliant with duty of candour requirements and had taken potential risks into account when planning services. Trust buildings and clinical equipment were mostly clean and well-maintained. Security arrangements and environmental risk assessments were effective. Most teams had put measures in place to reduce the impact of low staffing, and staffing was discussed regularly at all levels of the trust. Overall compliance with mandatory training was good. Medicines management on most of the wards was good. Staff reported and learned from incidents.
  • Within high secure services, there was a clear aspiration to reduce the use of seclusion and long-term segregation. The trust had recruited an additional 19 psychology staff since our last inspection, which had improved access to psychological therapies in the local division. The quality and range of psychological and occupational therapies in learning disability and autism secure wards was excellent. Therapeutic intervention and treatment provided in most of the core services was in line with best practice guidance. Staff evaluated the effectiveness of their interventions using standardised outcome measures and clinical audit. Care planning and record keeping was mostly effective throughout the trust.  The majority of staff were experienced and skilled, and compliant with trust requirements for supervision and appraisal. Multidisciplinary meetings and handovers were patient-focused and effective. The majority of staff understood and applied the Mental Health Act and Mental Capacity Act.
  • Almost all of the patients and carers we spoke with were positive about staff and the service. Patients said that staff were supportive, helpful and kind. All of the interactions we observed in five of the six core services we inspected were caring and respectful. Staff involved patients and carers in the care they received. Patients were oriented to the wards on their arrival. There were many opportunities for patients and carers to give feedback and help develop services.
  • The trust’s services were planned and delivered to meet the diverse needs of the population. There were good escalation procedures in place for delayed discharges. Staff took active steps to understand and engage people from disadvantaged groups and those with protected characteristics under the Equality Act 2010. Food provided to patients had improved since our last inspection. Patients on all but two of the wards we inspected had access to at least 25 hours of activity each week. Services met people’s individual needs, including disability, spiritual and dietary needs. The trust listened to and learned from complaints.
  • The trust had a clear vision, values and strategy. Safety and quality were paramount. The trust was financially stable and secure. Non-executive directors and the council of governors were effective in holding the trust to account. The trust had an up to date risk register and there were clear risk identification and review processes in place for risks at corporate and divisional level. There were effective surveillance systems in place and each division had a clear governance structure. Leadership at all levels was visible and effective. The trust was committed to its goal of developing a fair and just culture. Staff were aware of the whistleblowing policy and felt able to raise concerns. Overall, staff morale was good despite service pressures. Staff and patients were engaged in all aspects of strategy delivery.

However:

  • There was an infection control risk in patients’ laundry rooms on four of the medium secure wards. On the STAR unit, staffing was not sufficient to manage the level of need. There was low compliance with training in basic and immediate life support on three wards for older people with mental health problems and one ward for people with learning disabilities and autism. Medicines were not always managed safely in wards for older people with mental health problems and on the STAR unit.
  • Five trust policies referred to the out of date 2008 Mental Health Act Code of Practice, which meant staff were not following current guidance. The trust had not notified CQC of authorised Deprivation of Liberty Safeguards applications. This is a requirement of their registration. At Wavertree Bungalow, care plans for patients who were not independently mobile did not include a detailed moving and handling risk assessment. Also at Wavertree Bungalow, there was insufficient information in care records to enable staff to safely support two patients with epilepsy.
  • We observed negative interactions on wards for people with learning disabilities or autism. On Wavertree Bungalow, we saw staff ignoring patients, talking about patients in front of other patients, and failing to provide verbal reassurance during moving and handling.
  • There was a lack of meaningful activity on wards for people with learning disabilities or autism. On STAR unit we found that staff did not always use patients’ communication aids and could not control the level of noise in the environment to make it suitable for patients with sensory needs.
  • Some ward staff told us that low staffing levels were affecting their morale and making it difficult for them to perform their roles safely. The proportion of staff who would recommend the trust as a place to work was worse than the national average for mental health trusts. Governance at local level was not always effective.


CQC inspections of services

Service reports published 27 June 2017
Inspection carried out on 20 March 2017 to 23 March 2017 During an inspection of High secure services Download report PDF | 384.81 KB (opens in a new tab)Download report PDF | 600.44 KB (opens in a new tab)
Inspection carried out on 20 to 24 March 2017 During an inspection of Wards for older people with mental health problems Download report PDF | 394.51 KB (opens in a new tab)Download report PDF | 600.44 KB (opens in a new tab)
Inspection carried out on 8 March, 20 to 24 March and 30 March 2017 During an inspection of Other specialist services Download report PDF | 467.29 KB (opens in a new tab)Download report PDF | 600.44 KB (opens in a new tab)
Inspection carried out on 23 March 2017 and 30 March 2017 During an inspection of Wards for people with learning disabilities or autism Download report PDF | 355.26 KB (opens in a new tab)Download report PDF | 600.44 KB (opens in a new tab)
Inspection carried out on 20 to 24 March 2017 and 04 April 2017 During an inspection of Substance misuse services Download report PDF | 380.93 KB (opens in a new tab)Download report PDF | 600.44 KB (opens in a new tab)
Inspection carried out on 20, 21, 22, 23 and 31 March 2017 During an inspection of Forensic inpatient/secure wards Download report PDF | 346.77 KB (opens in a new tab)Download report PDF | 600.44 KB (opens in a new tab)
See more service reports published 27 June 2017
Service reports published 14 October 2015
Inspection carried out on 2 - 4 June 2015 During an inspection of Community-based mental health services for older people Download report PDF | 308.84 KB (opens in a new tab)
Inspection carried out on 1-6 June 2015 During an inspection of Acute wards for adults of working age and psychiatric intensive care units Download report PDF | 323.08 KB (opens in a new tab)
Inspection carried out on 2-4 &16 June 2015 During an inspection of Wards for older people with mental health problems Download report PDF | 333.36 KB (opens in a new tab)
Inspection carried out on 2- 4 June 2015 During an inspection of Mental health crisis services and health-based places of safety Download report PDF | 289.01 KB (opens in a new tab)
Inspection carried out on 2 - 4 June 2015 During an inspection of Long stay/rehabilitation mental health wards for working age adults Download report PDF | 324.7 KB (opens in a new tab)
Inspection carried out on 01 – 04 &17 June 2015 During an inspection of Forensic inpatient/secure wards Download report PDF | 365.83 KB (opens in a new tab)
Inspection carried out on 2-4 June 2015 During an inspection of Community mental health services for people with learning disabilities or autism Download report PDF | 332.62 KB (opens in a new tab)
Inspection carried out on 1 - 4 June 2015 During an inspection of Wards for people with learning disabilities or autism Download report PDF | 332.22 KB (opens in a new tab)
Inspection carried out on 2 - 4 June 2015 During an inspection of Community-based mental health services for adults of working age Download report PDF | 293.68 KB (opens in a new tab)
See more service reports published 14 October 2015
Inspection carried out on 01 June – 05 June 2015 16th & 17th June 2015

During a routine inspection

We found that the provider was performing at a level which led to an overall rating of good.

The trust was well led and had some exceptional leaders, managing in very challenging circumstances. The board was highly aspirational and committed to delivering services which were of high quality and where every person matters. It was clear that most staff across the organisation understood, and were committed to, the vision and values of the organisation. These were well communicated and the work to win both hearts and minds was apparent. For instance, staff at all levels of the organisation were able to clearly articulate the drive for zero tolerance to suicide and understood the no force first initiative.

The trust had new ways of working, such as peer support models and recovery colleges. We saw good evidence of involvement across both corporate and frontline services such as the service user assembly and the commitment by the trust to involve experts by experience in all recruitment drives.

Key stakeholders, including the clinical commissioning gropus and local authorities, were positive about the trust and relationships were transparent, open and honest, with a good degree of challenge. This was also true of the relationships at board level. We concluded that the board worked well together and were professional and respectful in their interactions. They were able to offer high challenge, without rancour or defensiveness. They were passionate about people and committed to understanding, first and foremost, the lived ‘experience’ of people who use services.

The trust had good systems in place which helped them understand what was happening on the frontline. These systems helped them respond quickly and efficiently to areas of concern. For example; a weekly surveillance meeting, led by the chief executive, identified ‘hotspots’. This may be where incidents had occurred, or where a complaint had been made, or where data was showing the potential for risk. Action plans were developed immediately and directors tasked to go back into the service and deliver on assigned tasks.

Alerts were sent out across services called ‘quality practice alerts’. These enabled other services to learn from serious incidents and complaints. It was expected that actions arising from this learning was disseminated across services.

The trust had good monitoring systems for assessing safety and quality through its Governance of Quality Framework. This had resulted in identifying very clearly those services, which require improvement and had detailed actions in place to address any areas of risk or concern.

The process for monitoring of risk was robust and the board were clearly sighted on both the corporate and operational risks facing the organisation. These were presented in board meetings via a risk register.

The structure of meetings and committees, which provide the board with assurance, were well embedded. Most had non-executive director oversight. This ensured that the trust have leaders who are more objective and were well placed, to provide the appropriate challenge.

We found the trust had the right policies in place to support staff in their work and that staff received relevant training and support. An exception to this was the Rathbone unit, where staff had not completed mandatory training, had not been adequately supervised or received an appraisal. There were gaps in staff understanding and application of the Mental Capacity Act and Deprivation of Liberty Safeguards in some teams. A requirement notice has been issued for the inpatient learning disability service, due to failure to ensure that documentation on capacity and consent to treatment and best interest decisions is completed.

We found that across the trust morale of psychologists’ was low and there was a lack of psychological support for people. We were pleased to see the trust had recently appointed a Head of Psychology. However, there were considerable access problems across the services in relation to psychological therapy and the trust have been issued with a requirement notice in this respect.

We found significant concerns in relation to one of the older peoples’ inpatient services and requirement notices have been put in place. These specifically relate to ensuring the dignity of patients is preserved. We were also concerned that Irwell ward was not a safe environment in relation to lay out of the ward and the use of glass doors and large glass reflective windows. Staff did not always meet the communication needs of individuals and during meal times food was not presented in an acceptable manner, for instance wrapped sandwiches were left on a table for patients to help themselves.

In forensic services there were concerns raised relating to some seclusion rooms which were not fit for purpose and did not comply with the Mental Health Act Code of Practice. The Trust responded immediately to our concerns and closed two seclusion rooms.

Intelligent Monitoring

We use our system of intelligent monitoring of indicators to direct our resources to where they are most needed. Our analysts have developed this monitoring to give our inspectors a clear picture of the areas of care that need to be followed up.

Together with local information from partners and the public, this monitoring helps us to decide when, where and what to inspect.


Joint inspection reports with Ofsted

We carry out joint inspections with Ofsted. As part of each inspection, we look at the way health services provide care and treatment to people.


Mental Health Act Commissioner reports

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.