England's Chief Inspector of Hospitals has told Devon Partnership NHS Trust that it must make improvements to some services following an inspection by the Care Quality Commission.
Overall, the trust has been rated as Requires Improvement for providing safe and effective services, and rated Good for being caring, responsive and well led. Inspectors found that Devon Partnership Trust had made significant and positive changes since its last comprehensive inspection by CQC in 2014 with the trust board having a clear strategy for improvement.
A team of CQC inspectors, specialist advisors and experts by experience visited hospitals and community services provided by Devon Partnership NHS Trust during July and August 2015. They assessed the services provided in all mental health wards for adults of working age, for older adults and for people with learning disability, long stay rehabilitation wards and forensic secure services. As part of the inspection they also visited community mental health services for adults of working age, older people and people with learning disability teams and the crisis intervention services and the health based place of safety provision.
Inspectors found that Community-based mental health services for adults and for people with a learning disability or autism and long stay mental health wards were rated Good as were the forensic secure wards, which were rated outstanding for their responsiveness Mental health crisis services were rated as requiring improvement
However, the mental health crisis teams did not offer a comprehensive, round-the-clock service. They did not always have enough staff to assess a new patient promptly and after 9.30pm the only crisis response was a night nurse practitioner, available by phone. Patients trying to contact the crisis teams for support might have to wait too long for an answer
Some wards were unsafe in their design and in the way in which staff managed the risks that this posed. Inspectors were particularly concerned by Haytor ward at Torbay Hospital, and Moorland and Ocean view at North Devon District Hospital which contained ligature anchor points which may be used by patients who were at risk of suicide. Staff had identified some of these ligature points but had not taken appropriate action to deal with the risks.
Difficulties in recruiting staff were affecting patient care. In some services, 30% of posts were vacant. This was a particular problem in forensic services where both staff and patients raised concerns about staffing levels. However, staff were found to be caring, compassionate and kind with patients and carers reporting that they were treated well.
The Deputy Chief Inspector of Hospitals (and CQC’s lead for mental health), Dr Paul Lelliott, said:
“While we found that staff were caring and respectful of the patients, the quality of clinical care was not consistently high across all services. Medical and nursing staff at the Cedars, Haytor ward and in the community mental health services for older people did not assess or monitor the physical health of patients adequately, and many patients did not have easy access to psychological therapies.
“We rated acute wards for adults of working age as requires improvement because, although the trust had identified the risks posed by the ward environment, they had not addressed them. On one ward, patients told us that they felt that staffing levels were too low.
“We rated a four of the nine core services as Good. These were the long stay wards, forensic services community mental health services for working age adults and for people with a learning disability.
“It is clear that there have been real improvements since the last inspection, although the trust recognise there are still further changes to be made. The board has a clear strategy for improvement that has been thought through carefully and we expect them to address the issues we have identified on this inspection. We will continue to monitor the trust's progress."
The inspection has identified a number of areas for improvement including:
- The trust must provide a dedicated telephone support line throughout the night for patients attempting to access the crisis teams.
- The trust must ensure care plans are recovery focused, contain crisis plans and reflect the views and voice of the patients.
- On the acute wards for adults the trust must ensure that work identified as high priority on the ligature risk assessments is completed in a timely manner. The potential risk caused by blind spots on Haytor ward must be dealt with, ensuring that all areas of the ward are included in ligature risk assessments.
- On the unit for learning disabilities and autism, the trust must ensure that people detained under the Mental Health Act (MHA) are being read their rights under Section 13 and patients are aware of their rights to access an independent mental health advocate by providing this information in an accessible format.
The report identifies a number of areas of good practice including:
- The Trust’s forensic/secure inpatient wards strong links with the local community had been developed, which meant that patients could take part in a range of voluntary opportunities. These opportunities included working in a church-run café, working in a charity shop or on a local farm. Patients with more restricted leave opportunities could also develop work skills by undertaking placements in the hospital café or car-valeting project.
- In the mental health services for people with learning disabilities or autism, the Devon attention deficit hyperactivity disorder (ADHD) service recognised that people newly diagnosed might struggle post-diagnosis. They ran workshops and groups to help people with topics such as establishing and maintaining positive relationships with family, friends and partners.
- On the unit for learning disability the team had recruited an expert by experience, who visits once a fortnight to conduct quality assurance audits. The expert by experience talks to staff and patients then feeds back any issues to the board of governors.
- Across the community mental health services for older adults staff regularly attended memory cafes, which have been established across the county, to offer support and advice to volunteers and people attending.
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