The Care Quality Commission (CQC) has published a report on wards for people with a learning disability or autistic people, run by Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, following on-site inspections on 16, 17, 18 July and 12 September last year.
Inspectors visited the Mitford Unit in Northumberland, Rose Lodge in Hebburn and Edenwood in Cumbria.
The July inspection was carried out after receiving concerns from external partners about the welfare of staff, specifically them being exposed to physical assaults from people using the service.
During the July visit, CQC found breaches of regulation regarding safe care and treatment, safeguarding, good governance and staffing. Due to these concerns CQC issued the trust with a Section 31 letter of intent under the Health and Social Care Act 2008. This informed the trust that if CQC didn’t see rapid and widespread improvements in these areas against an action plan they were told to submit, CQC would take enforcement action.
CQC then carried out another visit on 12 September to check on the progress of improvements which the service was told to make following the July inspection. At the September inspection, CQC felt assured the trust had a robust plan that the concerns have been or are in the process of being addressed. It also continues to provide monthly reports to CQC to show further improvements which are being made to keep people safe.
As well as the service being re-rated as requires improvement overall, as have the ratings for being safe, effective, responsive and well-led. Caring has dropped from good to requires improvement.
Victoria Marsden, CQC deputy director of operations in the north, said:
“When we inspected wards for people with a learning disability or autistic people at Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, we were concerned to find that some staff didn’t feel listened to and weren’t always being supported to carry out their roles safely, which was having an impact on people’s care.
“Before the inspection, we were notified by external partners about a high number of injuries to staff working at the Mitford Unit, often caused by physical assaults from people staying on the wards. During our visits we found that these concerns were substantiated, however the number of assaults on staff had reduced, but the use of restraint on people had increased.
“We weren’t assured that staff had the required skills and training to manage the complex nature of people’s individual needs, and we were concerned that this was why they were carrying out more restraint. One family member told us that they didn’t always feel their relative was safe and staying on the Mitford Unit actually made them feel worse.
“There had also been a significant number of injuries to people using the service in the 12 months before our visits. Records didn’t always show how these injuries were sustained, for example if it was due to being restrained or due to people hurting themselves. It also wasn’t clear if they’d been investigated, so lessons could be learnt to help prevent them from happening again and reduce the number of injuries people were sustaining.
“The trust had continued to use methods of physical restraint with people which didn’t follow national best practice guidelines, which could put people staying on the wards at significant risk of psychological harm.
“Additionally, people’s care plans didn’t always include which types of restraint should be used to keep them safe. However, since the inspection, the trust has informed us that they have started to address the issues we identified and are carrying out restraint in a safer way to prevent people from coming to harm.
“We’ve shared our findings with the trust and are receiving monthly reports to ensure people’s safety. We will continue to monitor the service closely, including through further inspections.”
Inspectors found:
- The trust did not have good enough oversight of the service to protect people from harm and abuse. Where leaders were aware of risks, actions hadn’t been taken quickly enough.
- Care plans were in place, but they lacked detail on what restraint should be used for people, and how staff should do it safely.
- The trust did not always work well with healthcare partners to safeguard people.
- Staff did not feel supported by ward managers and felt senior leaders were not always available or visible.
- There were delays in discharging people within appropriate timescales due to a lack of suitable accommodation for them to go to.
However:
- At Mitford Unit, the environment was clean and tidy. People's rooms were personalised and people had access to their own outside space.
- People were supported to receive their medicines in a way which met their needs.
Due to a large-scale transformation programme at CQC, this report has not published as soon after the inspection as it should have done. The programme involved changes to the technology CQC uses but resulted in problems with the systems and processes rather than the intended benefits. The amount of time taken to publish this report falls far short of what people using services and the trust should be able to expect and CQC apologises for this.
While publication of some reports has been delayed, any immediate action that CQC needed to take to protect people using services has not been affected. CQC is taking urgent steps to ensure that inspection reports are published in a much more timely manner.
The full report will be published on CQC’s website in the next few days.