A recent Care Quality Commission (CQC) inspection of Southern Health Foundation Trust has seen the trust’s overall rating drop from good, to requires improvement, overall.
Southern Health NHS Foundation Trust is one of the largest providers of mental health, specialist mental health, learning disabilities and community health services in the UK. Services are provided across Hampshire and the south of England.
During October and November, CQC carried out an unannounced comprehensive inspection of six of the ten core mental health services provided by the trust, as part of its continual checks on the safety and quality of healthcare services. These were:
- Wards for people with a learning disability or autistic people
- Child and adolescent mental health wards (CAMHS)
- Forensic inpatient/secure wards
- Acute wards for adults of working age and psychiatric intensive care units (PICU)
- Wards for older people with mental health problems
- Mental health crisis services and health-based places of safety
Following the inspection, the overall rating for the trust dropped from good to requires improvement. The rating for safe also dropped from good to requires improvement. Effective remains as requires improvement, while caring, responsive and well-led remain as good. The drop in ratings reflects specific concerns that inspectors had about safety issues. However, the trust has a new, stable, highly skilled and experienced leadership team in place, and they were taking action to address these issues and make improvements.
The overall rating for wards for people with a learning disability or autistic people dropped from outstanding to good.
The overall rating for the child and adolescent mental health wards remained as good overall.
The overall rating for forensic inpatient/secure wards and acute wards for working age adults and psychiatric intensive care units dropped from good to requires improvement.
The rating for mental health crisis services and health-based places of safety and wards for older people with mental health problems remain as requires improvement.
Karen Bennett-Wilson, CQC’s head of hospital inspection, said:
“When we inspected Southern Health NHS Foundation Trust, we found a stable and capable leadership team who understood the challenges facing the trust and were focused on addressing these in order to make improvements. Learning was a priority, both from things that had gone well and not as well. Overall, the culture was positive and supportive. Staff were proud to work for the trust and we saw that staff at all levels put patients at the heart of everything they do.
“We are, of course, mindful of the additional pressures that the trust was under as a result of the COVID-19 pandemic, and we acknowledge and commend the innovative and responsive solutions that that were put in place to continue to provide care and treatment to patients in what were very challenging circumstances. However, we did find areas of concern which led to a drop in the overall rating of the trust.
“In particular, we were concerned that the trust did not have enough staff to meet people’s needs in four of the six services we visited, and this was leading to low morale in some areas. Some staff said that they felt pressurised to admit patients onto wards when it was unsafe to do so, and we were told the number of injuries to staff and patients during incidents of aggression on the acute wards and PICU was increasing. However, the trust had plans in place to recruit more staff and understood that this needed to be a priority.
“We also had serious concerns about safety of patients on Beaulieu Ward, one of the wards for older people with mental health problems, and told the trust that it must make urgent improvements. However, I am pleased to report that swift action was taken to reduce the number of beds and increase staffing levels, ensuring that the immediate risks to patient safety were addressed.
“We have told the trust that it must now make a number of additional improvements and we will return to check that these have been made and fully embedded.”
Across the trust, inspectors found the following during this inspection:
- Staffing levels were not always being met, leading to pockets of low morale across the trust. In particular, a lack of staff in some of the wards for patients who needed additional support meant that they were not always kept safe, or provided with the required level of care
- Several strategies had been put on hold during the COVID-19 pandemic and there was still work to do to bring the clinical strategy and the wider trust strategy together into a comprehensive document that set out the direction clearly
- When a patient’s health is deteriorating, this should be recorded and escalated in line with national guidelines. However, in three of the services inspected, there were gaps in these records. Without complete records, a patient’s deteriorating health could have been missed and therefore not escalated.
However:
- The trust leadership was stable and capable. Since the last inspection the board had appointed a new chief executive and a new medical director. Two new non-executive directors also joined the trust during the pandemic. Leaders had the skills, knowledge, integrity and experience to perform their roles and had a good understanding of the services they were responsible for delivering. They were visible in the service and approachable to patients and staff
- All staff were respectful, compassionate and kind towards patients. Staff were also friendly, approachable and supportive and interacted positively with patients. Staff were highly motivated and provided care in a way that promoted patient’s dignity
- The trust engaged well with patients, staff, equality groups, the public and local organisations. Trade union representatives were very positive about how the trust leaders worked with them in an open and transparent way and had supported staff throughout the pandemic
- The trust had responded to, and investigated, serious incidents. Following the death of a patient at Parklands hospital, the trust commissioned an independent investigation and worked closely with the police
- Learning from serious incidents had been strengthened since the arrival of the new medical director. The trust used ‘favourable event reporting’ where they learned from things that had gone well in the same way they learned from things that had not gone so well. The aim was to replicate good practice and disseminate this across the trust
- The performance team delivered good quality reports for each division to have an overview of risk within the divisions and these were regularly reviewed
- Digital development and information governance systems were strong with consistent clinical and service line engagement
- In response to the COVID-19 pandemic, the trust adapted quickly, developing several innovative solutions to ensure that it was able to continue to provide safe care and treatment to people. For example, a virtual version of the Safe Haven Crisis Café (which offered a drop-in service prior to the pandemic), was established, and a mental health crisis car and ambulance, staffed by professionals with mental health training, were introduced. A mobile digital tool was also established which staff could use to work on care plans in conjunction with patients, in their own homes.
Full details of the inspection are given in the report published on our website.
For enquiries about this press release please email regional.engagement@cqc.org.uk.
Journalists wishing to speak to the press office outside of office hours can find out how to contact the team here (Please note: the duty press officer is unable to advise members of the public on health or social care matters).
For general enquiries, please call 03000 61 61 61.