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Care Quality Commission finds that Somerset Partnership NHS Foundation Trust requires improvement
England’s Chief Inspector of Hospitals has told Somerset Partnership NHS Foundation Trust that it must make improvements following a comprehensive inspection by the Care Quality Commission.
A team of inspectors has rated the trust Requires Improvement for providing safe, effective, responsive and well led services. The trust was rated Good for caring.
Somerset Partnership NHS Foundation Trust provides a wide range of integrated community health, mental health, learning disability and social care services to people of all ages. The trust provides services from 17 locations across Somerset.
Full reports from the inspection, including ratings for all core services will be available from 00:01 on Thursday 17 December at: www.cqc.org.uk/provider/RH5.
The CQC took enforcement action following its inspection in September 2015. Inspectors required the trust to carry out an immediate review of caseloads in its community mental health services for people with learning disabilities. It also required the trust to begin a comprehensive review of how it assessed patients and planned their care, to be completed by 31 March 2016. We revisited the trust in November 2015 to check on progress and found that many improvements had been made but that there was still more to do.
The Deputy Chief Inspector of Hospitals (and lead for mental health), Dr Paul Lelliott, said:
“We have found significant variation in the quality of care people receive from Somerset Partnership NHS Foundation Trust.
“We had serious concerns about the safety of community mental health services for adults with learning disabilities. We found that risk assessments for patients had not been undertaken, that care plans were not person-centred, a failure to mitigate risks to patients and staff, poor incident reporting and poor joint working with other organisations where responsibility for care was shared or transferred. Until the inspection the trust had failed to recognise the scale or the importance of these issues. We served the trust with a warning notice which required the trust to address these issues. We returned to the trust in November to assess progress and found that some improvements had been made; staff had received training in incident reporting, safeguarding and clinical risk assessment and management and a review of all patient cases to identify risks had been undertaken. We will continue to monitor the services closely until all the requirements of the warning notice have been met.
“We were also concerned about significant staff shortages in community health services for adults. These were placing excessive strain on district nurses and adversely affecting their ability to ensure that clinical risk assessments relating to nutrition, pressure care and falls were completed so that they could provide the appropriate care for all patients.
“While a number of the problems we identified can be attributed to the high rate of vacancies in some services, it also suggests a failure by the trust's management to maintain oversight of all the risks across all services and to ensure a robust and consistent approach to assessing and mitigating risk to patients.
“We did also find areas of good practice. The trust has a caring, enthusiastic and committed workforce that in the main treat patients with dignity and respect. Staff in all services took time to interact with patients and it was clear that there were good relationships between staff and their patients.
“The trust is taking action to address our immediate concerns. It has recognised that it needs to change in order to deliver, high quality care consistently to the people it serves. It has also recognised that it needs to engage much more effectively with its staff and the organisations that it works with as it goes through this period of change.”
At the time of the inspection, Somerset Partnership NHS Foundation Trust was undergoing a comprehensive review and re-design of its services and management structures.
The trust recognised it needed to address staffing shortages. However, it had no clear workforce recruitment and retention strategy in place to address staffing issues.
Some services had long waiting lists, but they did not always have systems in place to deal with the risks to people who were waiting for treatment.
In mental health services for adults of working age, reviews of serious incidents took in excess of 60 days to complete.
The quality of patient records varied from service to service and across teams. Care plans were not always person-centred and lacked the detail required to demonstrate an understanding of the individual`s circumstances and needs. Inspectors were concerned that some services which had a high number of referrals that staff were struggling to process, such as the memory assessment service. Important details were not always recorded in care plans and patients in mental health services did not always feel involved in planning their care.
The inspection identified a number of areas where the trust must improve including:
In long stay/rehabilitation mental health wards for adults of working age: The trust must ensure that capacity to consent to medication is undertaken and recorded for all detained patients.
The trust must improve the memory services. The trust must provide an effective management structure to teams at south Somerset and Taunton Deane.
In wards for older people with mental health problems The trust must ensure risks associated with the physical ward environments must be fully assessed and addressed.
In community health services: The trust must ensure that patients receive a thorough and timely assessment that includes essential observations and risk assessments that are necessary to detect deterioration in patients’ health and wellbeing.
The reports highlight several areas of good practice:
In end of life care. The end of life care coordination centre enabled patients to be discharged from hospital very quickly with the support of other health and social care professionals to make sure patients were able to die in their preferred place of death, their home.
The palliative care medical team was hosted by this trust but they worked across a number of other providers to include hospices and the acute trusts. This enabled them to maintain continuity of care for patients being cared for by any of these service providers.
In community child, adolescent mental health services. The deaf service introduced DVDs with letters and care plans translated into British sign language to help people understand them fully.
There was a group for the young people coming into the service. This was run with a young person using the service and a psychologist. Young people referred to the service were told about what CAMHS was and were given the opportunity to ask questions and play a game.
Acute wards and psychiatric intensive care. A psychiatrist on Rowan ward was providing a weekly psychotherapy clinic and was trained in eye-movement desensitisation and reprogramming, a NICE recommended treatment for trauma.
Rowan ward had developed a wellbeing practitioner role who assessed height, weight and blood pressure and offered advice and help on diet, smoking cessation, exercise and drugs and alcohol.
The reports which CQC publish today are based on a combination of its inspection findings, information from CQC’s Intelligent Monitoring system, and information provided by patients, the public and other organisations including Healthwatch.
The Care Quality Commission has already presented its findings to a local Quality Summit, 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.
For further information, please contact John Scott, Regional Engagement Manager on 07789 875809. Journalists wishing to speak to the press office outside of office hours can find out how to contact the team here. (Please note: the press office is unable to advise members of the public on health or social care matters.)
For general enquiries, please call 03000 61 61 61.
- Last updated:
- 29 May 2017
Notes to editors
Somerset Partnership NHS Foundation Trust provides a wide range of integrated community health, mental health, learning disability and social care services to people of all ages. The trust provides services from 17 hospitals 3 community hospitals and from four hospital sites from where it provides mental health inpatient services. The trust also provides services to people in the community team bases, in GP surgeries and local clinics, in a range of non-NHS community settings and at home.
Bridgwater Community Hospital, West Mendip Community Hospital, Dene Barton Community Hospital, Wellington Community Hospital, Wincanton Community Hospital, Frome Community Hospital, Burnham On Sea War Memorial Hospital, South Petherton Community Hospital, Chard Community Hospital, Williton Community Hospital, Shepton Mallet Community Hospital, Minehead Community Hospital, Crewkerne Community Hospital.
CQC has produced one overall report on the trust, plus separate reports on each of the following core services:
- Acute wards for adults of working age and psychiatric intensive care units (PICU's)
- Long stay/rehabilitation mental health wards for working age adults
- Forensic inpatient / secure wards
- Child and adolescent mental health wards
- Wards for older people with mental health problems
- Wards for people with a learning disability or autism
- Community-based mental health services for adults of working age
- Mental health crisis services and health based places of safety
- Specialist community mental health services for children and young people
- Community-based mental health services for older people
- Community mental health services for people with a learning disability or autism
- Community health services for adults
- Community health services for children, young people and families
- Community health inpatient services
- End of life care
- Community dental services
- MIU Urgent Care
- Sexual Health