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St Mary's Hospital (Mental Health Management) Good

This service was previously managed by a different provider - see old profile

Inspection Summary


Overall summary & rating

Good

Updated 9 September 2014

The Isle of Wight NHS Trust is an integrated trust providing acute, ambulance and mental health services, and community services. Mental health services are provided to a population of approximately 140,000 people living on the Island. Services include community mental health services, which includes Early Intervention in Psychosis, inpatient acute and rehabilitation services, community child and adolescent mental health services (CAMHS), a tier 3 drug and alcohol service,  a memory service, a community learning disability service and an intensive outreach service for residential and nursing care homes.

We carried out this comprehensive inspection because the Isle of Wight NHS Trust is an aspirant Foundation Trust, prioritised by Monitor for inspection. We inspected this core service as part of our second phase of the new comprehensive inspection programme introduced for mental health services.

The announced inspection took place between 4 and 6 June 2014, with an unannounced visit on 21 June between 4pm and 11pm.

Overall, we rated the Isle of Wight NHS Trust mental health services as ‘good’. The trust was good for providing safe, effective, caring and responsive services. Leadership at a service level was good, but the overall trust leadership of services ‘requires improvement’.

All services were rated as “good” with the exception of community mental health services which were rated as “requires improvement”.

Key findings related to the following:

  • People told us that they were involved in their care, and that staff were caring and working within their capacity, and treated them with dignity and respect. However, people being treated by community mental health services had less involvement in their care, and little information about the services available to them.
  • We received 26 comment cards from people who use the mental health service. All were negative and people felt staff were oppressive and controlling.
  • Staff were aware of the safeguarding processes and most had received safeguarding training.
  • The majority of people who used the services, and were treated by staff, said they felt safe; however, there were examples of people stating that, at times, low staffing numbers affected people’s care and treatment.
  • Staffing levels were considered to be adequate in most areas, but there were concerns about capacity on Shackleton Ward and in community mental health services. Staff reported that no action around recruitment had been taken for some time in these areas. A staffing review had just been completed by the trust, and a recruitment plan had been produced and signed off by the executive board.
  • Incidents were reported, and lessons were learned and shared across services, to minimise risks and prevent reoccurrences. However, staff in community mental health services were under-reporting incidents because of limited staff capacity within the service.
  • People were treated according to national guidelines, and had good access to psychological therapies and activities in inpatient settings.
  • Outcomes of care were monitored and reported, both nationally and locally, to improve the effectiveness of services. However, this was not evident in community mental health services, where patients were not monitored or reviewed appropriately to assess their progress or recovery.
  • There was effective multidisciplinary working, and innovative working in some services with social care, housing, employment, the police and GPs to co-ordinate people’s recovery and support their independence and self-care.
  • Staff told us that they received appropriate training; however, the uptake of this training required improvement in some areas.
  • Clinical, managerial and caseload supervision was offered and taken up in most areas, with the notable exception of the Rehabilitation and recovery team in community mental health services , where improvements are required.
  • People received care and treatment at the right time, although there were long waiting times for assessment and treatment in community mental health services.
  • People had good access to advocacy services.
  • The complaints procedure was clear, and understood by staff and people using the service.
  • Processes for staff to deal with incoming issues, concerns and complaints were understood, and trust-wide learning from complaints was cascaded in a variety of formats to all service areas.
  • Staff generally felt supported by their line manager and peers, but felt isolated and disconnected from the trust in some services. The trust had governance structures in place, which included the mental health services, but it was observed that the flow of information did not always cascade to ward and community staff.
  • Staff said they could approach their manager with any concerns, and said they thought any concerns would be addressed. Risks were appropriately managed, but in some services, risk issues were sometimes not addressed, or not always acted upon in a timely manner.
  • Mental health services did not have an overall clinical strategy, and did not have appropriate representation on the trust board to reflect the workings of an integrated trust.

Mental Health Act Responsibilities

  • The Mental Health Act records we reviewed were comprehensive and in order.
  • People’s mental health capacity was assessed at ward reviews, and recorded in the trust’s electronic recording system.
  • The Mental Health Act manager kept the ward staff up to date with any actions that may be required, such as adherence to the conditions of a Section 47/49, and the need to liaise with the Ministry of Justice (MOJ).
  • Reminders were also fed into the ward round process, so that the multidisciplinary teams could review Mental Health Act sections, ensuring good governance processes, in line with the Code of Practice (CoP).
  • There were posters displayed in the ward informing people of the Independent Mental Health Advocacy service (IMHA). We spoke with the ward manager, who told us that any person detained under a section of the Mental Health Act would automatically be referred for an Independent Mental Health Advocate.

We have identified areas of outstanding practice. However, there were also areas of poor practice, where the trust MUST make improvements, and other areas of practice where the trust SHOULD take action to improve. These are identified in this report.

Professor Sir Mike Richards

Chief Inspector of Hospitals

August 2014

Inspection areas

Safe

Good

Updated 9 September 2014

Mental health services had effective procedures to provide safe care and treatment. The staff were aware of potential risks, and these were identified in risk registers. Incidents were reported and investigated, and lessons were learnt and shared to prevent reoccurrence. Safeguarding was well established, and people were protected from abuse. In some services, however, staffing levels were affecting incident reporting and risk management; staff had high caseloads and people did not have appropriate risk assessments. 

Effective

Good

Updated 9 September 2014

People were treated according to national and best practice guidance. Staff worked effectively in multidisciplinary teams to centre care around people. People’s care was individualised, and there were a range of treatment approaches available to meet people’s needs. Staff were well trained, and had good access to training and development opportunities. Staff told us that they were well supported by their managers.

There were appropriate policies and procedures for people detained under the Mental Health Act. Some services were less well developed in providing effective care.

Caring

Good

Updated 9 September 2014

The mental health services were caring, and people were extremely positive about the quality of the care and treatment they were receiving, and the approach of the staff. Across all areas we observed staff treating patients with dignity and respect. People told us they were involved in their care, although this was not the case in community mental health teams, and care plans did not always have documented evidence of this. We did receive some negative feedback via comment cards collected post inspection, where people described oppressive and controlling services, and staff behaviour.

Responsive

Good

Updated 9 September 2014

Services were developed according to the needs of people on the Island. People had good access to services across a number of different community sites, although some services, such as in community mental health, had long waiting times. People had good access to information about services and treatment, and access to advocacy services. Complaints were taken seriously, investigated and responded to promptly.

Well-led

Requires improvement

Updated 9 September 2014

Leadership at service level was good, but required improvement overall at trust level. There was not a clear strategy for mental health services. The trust is developing a Strategic Partnership with Hertfordshire Partnership University NHS Foundation Trust, but staff were not aware what this meant for services, and how services would develop in the future. Staff felt supported by their line manager and peers, and considered that senior managers in the trust were accessible, but they did, at times, feel disconnected from the wider trust. There was responsible governance in mental health services, and staff were using and learning from audit, incidents and complaints. However, risks were not appropriately managed in some services. Public engagement was good and many services had innovative practice.

Checks on specific services

Child and adolescent mental health wards

Good

Updated 9 September 2014

The CAMHS provided by the Isle of Wight NHS Trust were delivered in a safe and caring manner. We found that staff were kind, friendly and delivered care which demonstrated a responsive manner when working with children, young people and their families. We observed that children and young people received a good service.

The team was in the process of moving from hard copy records to electronic records, and this had created some difficulties regarding how some of the information was being transferred and recorded. Information about assessments and care could not be easily located. Incidents were reported and some lessons learnt, but not all information on reported incidents was fed back to teams.

Staff demonstrated a good understanding of how to follow the local safeguarding policy and procedures for safeguarding children, and worked well with other trust teams and external agencies, to provide care that best met the needs of children and young people. The team worked collaboratively as a multidisciplinary team with a varied skill mix. The use of outcome measures of effectiveness was routine, and information was shared nationally and locally.

The CAMHS had an understanding of the specific needs of the population they served, and delivered care which was largely responsive to people’s needs. Children did not have long waiting times for care and treatment, although some children who required inpatient services for a longer period of time were placed off the Island.

Children could provide feedback to the service and this was acted upon. Staff told us that they felt supported by their managers, and were proud of their team and to work for the trust. The quality of the service provided was monitored, and necessary measures were taken to improve performance.

Mental health crisis services and health-based places of safety

Good

Updated 9 September 2014

The CRHT team provided care to people in a compassionate and kind manner. We spoke with staff who understood local needs, and described involvement of those important in people’s lives as being central to their work. Carers told us that their needs were always considered when staff visited. They had information made available to them in a variety of formats to meet individual needs. People told us that they were given information to refer to throughout their care.

The team had effective systems to prioritise referrals, safeguard people and report incidents. There was a regular audit of prescribing and medicines, to ensure the safe management of medicines. There was a multidisciplinary approach to risk management, and people were treated according to nationally-recognised guidance, although there were no specific systems to monitor outcomes of care. Partnership working with community teams and inpatient wards meant that there were effective outcomes for people, such as around early discharge from hospital.

'Operation Serenity' (a joint venture with the police) was proven to have a positive impact upon people’s experiences when they presented in the community with a mental health issue. The team had a good record of gatekeeping all admissions to inpatient beds, and people were given increased choice about the care they received and where this was provided.

Staff attended alongside the attending approved mental health professional (AMHP), to people being assessed under the Mental Health Act, to offer support from the team as an alternative to hospital admission where appropriate. Complaints were handled according to trust policy, and people had access and information on advocacy services.

The CRHT team were cohesive and felt well supported by management. Robust systems were in place to ensure effective supervision and appraisal of staff. Staff described managers as accessible to them, and regularly consulted with them via a variety of formats. The service was regularly audited to establish levels of performance and outcomes for people using the service. Feedback from people and carers was regularly sought and used to improve the service. 

Wards for people with learning disabilities or autism

Good

Updated 9 September 2014

The CLDT services provided by the Isle of Wight NHS Trust were delivered in a safe and caring manner. We found that staff were polite, and delivered care which demonstrated good skills when working with people with learning disabilities and their families. We observed that delays were experienced in receiving psychological therapies, but on the whole, people received a good service.

The team was in the process of moving from hard copy records to electronic records, and this had created some difficulties regarding how some of the information was being transferred and recorded. Information about assessments and care could not be easily located. Staff told us this was work in progress and it was taking a lot of their 'hands on' time.

Staff demonstrated a good understanding of how to follow the local safeguarding policy and procedures for safeguarding vulnerable adults, and they worked well with other trust teams and external agencies to provide care that best met the needs of people. The team worked as a robust multidisciplinary team with a diverse skill mix. The use of outcome measures of effectiveness was routine, and information was shared nationally and locally.

There were systems in place for people to give feedback to the service, and this was acted upon. Staff told us that they felt supported by their managers, and were pleased to work for the trust. Quality was monitored, and the team took necessary measures to improve their performance.

Substance misuse services

Good

Updated 9 September 2014

We found that the Island Drug and Alcohol Services (IDAS), provided by Isle of Wight NHS Trust, were delivered in a safe and caring way. We found that staff were respectful, and delivered care which demonstrated good skills for working with people who misuse drugs and alcohol, and their families. We observed that care and treatment was delivered in a timely manner; there were no people on waiting lists.

We found that the team were concerned about the service going to tender in July 2014. This meant that staff were worried as to whether the Isle of Wight NHS Trust would continue to provide the service, or whether it might be given to another provider.

Staff demonstrated a good understanding of how to follow the local safeguarding policy and procedures for safeguarding vulnerable adults and children, and worked well with other teams, within the trust and outside organisations, to provide care that best met the needs of people. There was good use of national guidelines to treat patients, and outcomes were monitored routinely to improve the service.

People who used the service were able to provide feedback and also knew how to complain. The majority of staff told us that they felt well supported by their managers, and were pleased to work for the team and the trust. However, one staff member felt that the senior management did not listen to their concerns.

We found that the team had arrangements in place to monitor the quality of the service provided, and took necessary actions to improve performance.

Acute wards for adults of working age and psychiatric intensive care units

Good

Updated 9 September 2014

The Acute, PICU (psychiatric intensive care unit) and Section 136 place of safety services provided by the Isle of Wight NHS Trust were safely delivered in a caring manner. Staff displayed their skills in working with people, and were supportive and kind. Incidents were reported through the trust incident systems, with regular feedback and debrief to staff to ensure that they were kept informed.

Staff demonstrated a good knowledge of the local safeguarding policy, and procedures for safeguarding vulnerable adults, and worked well with other trust teams and external agencies to provide care that best met the needs of people. We saw that the wards worked as part of a multidisciplinary system, with a wide range of skilled professionals. There was goal setting and regular audits of care plans, and the use of outcome measures of effectiveness.

There were systems in place for people to give feedback to the service, and action was taken to improve the service. Staff told us that they felt supported by their managers, but felt disconnected from the rest of the trust.

There were systems in place to monitor the quality of the service provided, and action was taken to improve performance. The service had had eight locum consultants in the past five years, and this was affecting the consistency of consultant cover, leadership for the ward and consistency of treatment for the people admitted to hospital. 

Rehabilitation services

Good

Updated 9 September 2014

There were effective procedures for staff and people using the service, to report both low-level and serious incidents. These were reported to relevant agencies, investigated, and reviewed to prevent a reoccurrence. Staff had access to training to safeguard vulnerable adults, and some staff had received training on the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The Mental Health Act (1983) was applied appropriately, and all documentation was current and in line with the Mental Health Act Code of Practice.

People were assessed and treated according to nationally-recognised pathways of care, and their health needs were being addressed. People were provided with psychological therapy, such as cognitive behaviour therapy (CBT). Staff and managers had regular supervision and appraisal, and new and temporary staff had induction. Staff worked in multidisciplinary teams to co-ordinate care, and were involved in goal setting and regular audits of care plans, but the use of outcome measures of effectiveness was not routine.

People were involved in their care and treatment; there was information on independent mental capacity advocates, and independent mental health advocates were available should people wish to talk with them.

There was a clear vision and strategy for the service; however, the unit did not have a clear understanding of the trust’s overall vision and strategies, and staff felt disconnected from the wider trust.

Other CQC inspections of services

Community & mental health inspection reports for St Mary's Hospital (Mental Health Management) can be found at Isle of Wight NHS Trust.