The Care Quality Commission (CQC) has published a report following an inspection of Birmingham and Solihull Mental Health NHS Foundation Trust in October, November and December.
The inspection was carried out as part of CQC’s continual checks on the safety and quality of healthcare services. The well-led key question for the trust overall was also inspected because it was rated requires improvement at the last inspection.
Inspectors visited five mental health services at the trust: acute wards for adults of working age and psychiatric intensive care units, mental health crisis services and health-based places of safety, rehabilitation services, wards for older people with mental health problems and forensic inpatient or secure wards.
Following this inspection, CQC issued a warning notice to focus the trust’s attention on rapidly making the necessary improvements to keep people safe due to concerns found within the acute wards for adults of working age.
Following the inspection, the trust’s overall rating for caring and responsive remained as good. Safe, effective and well-led remained as requires improvement.
The overall rating for Birmingham and Solihull Mental Health NHS Foundation Trust remains requires improvement.
Lorraine Tedeschini, CQC director of operations in the Midlands, said:
“When we inspected Birmingham and Solihull Mental Health NHS Foundation Trust, we found improvements were needed in several areas to ensure people’s safety.
“Understaffing was a big concern, and while many NHS services and those in the wider care sector face staffing challenges, the trust must find ways to minimise the risk this poses to people in its care. We found some shifts where there weren’t enough qualified nurses on duty, as well as low levels of staff supervision across some services meaning staff weren’t getting the appropriate support to deliver safe care.
“This understaffing issue had a direct effect on people’s care and well-being and resulted in a lack of activities being available for people on most wards. People’s access to support from occupational therapists and psychologists was also low on most wards.
“However, since our last inspection the trust has appointed a new chief executive and a new board has been formed which is developing a clear strategy and vision, with leaders who are passionate about positive change and improvement.
“Despite understaffing issues, staff must be commended for treating people with compassion and kindness and understanding their individual needs.
“We will continue to monitor the trust and will return to check if the necessary improvements have been made. If we find this is not happening, we will not hesitate to take further action to keep people safe.”
Inspectors found the following during this inspection:
- Staff compliance with mandatory training in immediate life support and safeguarding was low in three of the five core services visited.
- There was a lack of activities available for patients on most wards we visited.
- Patient access to support from occupational therapists and psychologists was low on most wards.
- Not all patients that needed them had risk assessments in place, and risk management plans did not always detail how identified patient risks were to be managed.
- Some staff told us that leaders rarely visited services with some staff being unaware of who senior leaders were.
However:
- Staff followed best practice in anticipating, de-escalating, and managing challenging behaviour.
- Whilst we had concerns about the environments at Reaside, and the Caffra seclusion suite, most ward environments were clean, well-maintained, and fit for purpose.
- The trust was developing the presence of the patient voice at board level, and whilst leaders acknowledged improvements were needed in this area, there was a clear strategic aim to get this right.
- Staff managed discharge well; planning this from an early stage and making clear plans with patients.
- Patients had good access to services and waiting times were in line with trust policy.