Lancashire Care NHS Foundation Trust is rated as Requires Improvement by the Care Quality Commission

England's Chief Inspector of Hospitals has told Lancashire Care NHS Foundation Trust that it must make improvements following an inspection by the Care Quality Commission.

CQC has rated the trust as Requires Improvement overall. It was rated as Good for being caring and responsive, and Requires Improvement for whether services are safe, effective and well-led.

Lancashire Care NHS Foundation Trust specialises in inpatient and community mental health services. It also provides health and wellbeing services for a population of around 1.5 million people

A team of CQC inspectors, expert specialist advisors and people who have experience of using services or caring for someone who uses services spent four days at the trust in April and May. CQC has published 17 separate reports on the services provided by the trust in hospitals, in clinics, and in the community.

Full reports including ratings for all core services are available.

The trust had revised its governance committee structure shortly before the inspection. These changes had not bedded in and the trust was experiencing the problems associated any major restructuring but had yet to realise the potential benefits. CQC concluded that the recent changes had adversely affected the quality of the communication links between the board and the clinical directorates.

Many of the children’s services were being delivered from locations that were not owned by the trust. These locations were not suitable environments for the services they were delivering.

The trust had experienced challenges with staffing levels across its mental health wards following the relocation of some wards. In some mental health services, there were not enough experienced staff to meet patients’ needs.

In the forensic wards, patients’ needs were recognised but not always met owing to shortages of staff, which meant access to meaningful activities and leave was inconsistent.

CQC found gaps in service provision for young people aged 16-18 years old, including the lack of an appropriate transitional pathway for patients moving from Child and Adolescent Mental Health Services (CAMHS) to adult services.

Compliance with compulsory training, appraisals and supervision was inconsistent across all services and the trust was not meeting its own targets. In acute wards and psychiatric intensive care units, there was a significant shortfall – just 11 per cent of staff had completed mandatory training.

While waiting times for community services were reasonable, people who needed an appointment with the chronic fatigue service were having to wait 60 weeks on average, when the expected wait was supposed to be six weeks. Waiting times for children’s services were improving.

Deputy Chief Inspector of Hospitals (and lead for mental health), Dr Paul Lelliott, said:

“The quality of the services provided by Lancashire Care NHS Foundation Trust was mixed. Some of the wards and community mental health facilities were not well maintained. Some wards had furnishings or fittings that posed a danger to people who are at risk of suicide. The trust has known about some of these problems for several years. It is disappointing that it has not taken action sooner to reduce these risks.

“The trust must also work harder to fill some of the vacant posts that are affecting the quality of care provided by some of its services.

“There were some areas of good practice. Across all of the community health services, mental health services (inpatient and community) and the adult social care homes we inspected, we saw most staff being responsive, respectful, caring and kind when interacting with patients.

“We have told the trust that it must make a number improvements to bring its services overall up to a level that would earn a rating of Good. The trust has recently reorganised its governance committee structure. These changes have yet to have a beneficial effect and senior managers must ensure that they are fully in touch with the front-line staff.

“This report presents the detail of our findings, our ratings and our recommendations. We met with the trust’s senior managers to pass on our preliminary findings at the time of the inspection. We held a quality summit on October 22 at which we heard what the trust leadership has already done to bring about improvement and their future plans. Our inspectors will return at a later date to check that progress continues to be made.”

CQC has identified a number of areas where the trust must improve including:

• There must be a protocol in place for the transfer of young people from CAMHS to adult mental health services and that this is fully adhered to by staff.
• In forensic inpatient and secure wards, the trust must ensure that ligature risks are removed from Calder ward, Greenside ward, Fairsnape ward and The Hermitage.
• The trust must make sure that seclusion rooms on Calder, Greenside and Fairsnape wards afford patients privacy.
• In community end of life care, the trust must ensure nurse staffing levels, the skill mix and skills of nursing staff are appropriate to meet the needs of patients.
• In community health services for children, young people and families, the premises must be are safe to use for their intended purpose.

The inspection team found several areas of good practice, including:

• In community-based services for people with learning disabilities or autism there was a dementia intervention service being piloted in the East Lancashire district and developed by the Burnley, Pendle and Rossendale Team.
• In the mental health crisis teams and health-based places of safety, the referral system enabled anyone to refer into the service, 24 hours a day, seven days a week, including self-referrals from people or their carer’s.
• The development of the health-based places of safety and joint working arrangements with the police reduced the numbers of people being assessed in police cells.
• The Scarisbrick Unit at Ormskirk was piloting the alternative therapy intervention project, which was aiming to offer an alternative to hospital admissions by offering daily placements for people in crisis and receiving support from the home treatment team

The Care Quality Commission has 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.

Ends

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