You are here

Provider: Solent NHS Trust Good

Inspection Summary


Overall summary & rating

Good

Updated 27 February 2019

Our rating of the trust improved. We rated it as good because:

We rated safe, effective, responsive and well-led as good. The rating for caring improved from good to outstanding. We rated seven of the trust’s 16 services as good. In rating the trust, we considered the current ratings of the primary medical services for general practices rated separately to this report and eight other services not inspected this time.

We rated well-led for the trust overall as good.

  • Leadership teams were visible and supportive to frontline staff and demonstrated good knowledge and understanding of the services they provided.
  • There was a positive organisational culture, which supported openness and transparency. Staff were mostly very happy to be working for Solent NHS Trust and spoke highly of their leaders.
  • Managers involved staff in changes to services.
  • Staff understood their responsibilities to raise concerns, to record safety incidents, concerns and near misses and to report them internally and externally.

  • Staffing levels, skill mix and caseloads were planned and reviewed so that people received safe care and treatment.

  • Staff had access to necessary equipment and medicines; and had a range of policies and procedures based on national standards to support their practice.
  • Medicines were appropriately prescribed and administered to people in line with the relevant legislation and current national guidance, and had improved since our last inspection.
  • People’s physical, mental health and social needs were holistically assessed and their care and treatment delivered in line with legislation, standards and evidence-based guidance.
  • Multidisciplinary working was strong across the services. Staff worked well together and with other organisations to deliver effective care and treatment.
  • The services had clear arrangements for supporting and managing staff to deliver effective care and treatment.
  • Staff had annual appraisals and managers encouraged staff and supported opportunities for development.
  • Staff were kind caring and treated patients with dignity and respect. Patients spoke of the positive care they received from staff.
  • Staff communicated with people so they understood their care, treatment and condition; and advice was given when required. Staff involved carers and families in the patient’s care, where appropriate.
  • Services delivered were accessible and responsive to people with complex needs or in vulnerable circumstances.
  • People with the most urgent needs had their care and treatment prioritised. Waiting times were within the trust target.

However,

In the community services we found:

  • Equipment was not always available in a timely way. For adults as well as children and young people there were delays with the provision of or repairs to wheelchairs.
  • Electronic recording systems could not provide assurance about staff completion of appraisals or mandatory training. The figures provided by the trust indicated that some staff were not meeting the statutory and mandatory training targets set by the trust. The trust set training to zero each business year but this did not show assurance that any staff overdue training had dates set in a timely manner.
  • Although the service had systems for identifying risks, not all risks were formally identified which meant there were missed opportunities for escalation to plan to eliminate or reduce them.
  • Staff in some teams had limited understanding about the Freedom to Speak up Guardian role
  • Staff had variable understanding of their responsibilities towards the duty of candour legislation
Inspection areas

Safe

Good

Updated 27 February 2019

Our rating of safe improved. We rated it as good because:

In community services we found:

  • Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.
  • Most areas of the service controlled infection risk well. Staff kept themselves, equipment and the premises clean. They used control measures to prevent the spread of infection.
  • Risks to patient’s carers and families were assessed, monitored and managed appropriately.
  • The service followed best practice when prescribing, giving, recording and storing medicines. Patients received the right medication at the right dose at the right time.
  • The service managed safety incidents well. Staff recognised incidents and reported them appropriately, Managers investigated incidents and shared lessons learned with the whole team and the wider service.
  • The service had suitable premises and equipment and looked after them well.
  • The service had enough medical and nursing staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment. However, staff turnover rates were higher than trust targets for some roles.
  • Staff kept detailed electronic records of patients’ care and treatment. Most records were clear, up-to-date and easily available to all staff providing care.

However:

  • Electronic recording systems could not provide assurance about staff completion of mandatory training. The figures provided by the trust indicated that some staff were not meeting the statutory and mandatory training targets set by the trust. The trust set training to zero each business year but this did not show assurance that any staff overdue training had dates set in a timely manner.
  • Equipment was not always available in a timely way. Patients were subject to significant delays in the provision of or repairs to wheelchairs, which affected the safety and well-being of many patients receiving community services. Ordering procedures resulted in delays of equipment for some patients.

In mental health services we found:

  • Staff knew what incidents to report and how to report them. All staff understood their responsibilities in relation to safeguarding. Managers identified learning from incidents and changed practice to prevent incidents reoccurring. Staff demonstrated that changes had been made as a result of learning from incidents.
  • The environments we visited were safe and clean. Furniture was in good condition. Staff adhered to infection control principles.
  • There was enough staff employed in services with the correct skills to meet the needs of patients.
  • Staff assessed patient risks and these were comprehensive.

However:

  • Medications management was not always safe in the acute wards for adults of working age. Governance systems for prescribing and medicines management did not identify prescribing risks to patients.
  • There was limited access to psychological therapies in the long stay/rehabilitation wards and wards for older people with mental health problems.

Effective

Good

Updated 27 February 2019

Our rating of effective improved. We rated it as good because:

In community services we found:

  • The service mostly provided care and treatment based on national guidance and evidence of its effectiveness. Managers checked to make sure staff followed guidance.
  • Staff in health visiting and school nursing, educated families and carers about nutritional health.
  • The service made sure staff were competent for their roles. Managers appraised staff’s work performance and held supervision meetings with them to provide support and monitor the effectiveness of the service.
  • Staff worked together as a team to benefit patients. Doctors, nurses and allied healthcare professionals supported each other to provide good care. There was joined up working with other organisations.
  • Staff understood their roles and responsibilities under the Mental Capacity Act and Gillick competency framework with respect to issues of consent and capacity. The service provided care and treatment based on national guidance and evidence of its effectiveness.
  • The service made adjustments for patients’ religious, cultural and other preferences.
  • The trust supported national priorities to improve the population’s health and staff had access to health improvement training included weight management intervention, drug and alcohol dependency intervention and smoking cessation.
  • Staff always had access to up-to-date, accurate and comprehensive information on patients’ care and treatment. All staff had access to an electronic records system that they could all update.

However:

  • Electronic recording systems could not provide assurance about staff completion of appraisals. The trust set training to zero each business year but this did not show assurance that any staff overdue training had dates set in a timely manner.

  • While staff we interviewed understood the relevant consent and decision-making requirements of legislation and guidance, including the Mental Capacity Act 2005, the figures provided to us by the trust indicated some staff may not have the required training annually. Care plans in the special schools did not always detail the current care and support the student.

In mental health services we found:

  • Staff completed care plans with all and these were updated as required. Care plans were holistic, recovery orientated and personalised. Staff documented patient involvement in their care plans.
  • Staff completed full assessments of patients’ mental and physical health needs. Patients had good access to physical healthcare.
  • Staff were participating in quality improvement programmes and audited their practice. There was an audit programme which supported staff to monitor and develop services.
  • Staff received an annual appraisal and received supervision regularly in the majority of services.
  • Staff understood their roles and responsibilities under the Mental Health Act and the Code of Practice. Staff followed the Mental Health Act Code of Practice, including access to advocates, reading patients their rights and paperwork associated with the Mental Health Act.

However:

  • Access to psychological therapies and interventions were limited on the long stay/rehabilitation and older persons wards.
  • Staff appraisals and supervision was not always recorded in line with the provider`s policy in the long stay/rehabilitation service.
  • Staff were not referring patients to independent mental health advocates or independent mental capacity advocates to patients in the community based mental health services for older people.

Caring

Outstanding

Updated 27 February 2019

Our rating of caring improved. We rated it as outstanding because:

In community services we found:

  • Staff cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness.
  • Staff involved patients and those close to them in decisions about their care and treatment.
  • Staff provided emotional support to patients to minimise their distress.

In mental health services we found that:

  • All patients we spoke with told us staff treated them with kindness and respect.
  • Patients were respected and valued as individuals and empowered as partners in their care.
  • Patients were active partners and felt involved in their care. Staff were committed to working in partnership with people.
  • Patients emotional and social needs were highly valued by staff and were embedded in their care and treatment.
  • Staff sought feedback from patients and carers about the service they had received.

Responsive

Good

Updated 27 February 2019

Our rating of responsive stayed the same. We rated it as good because:

In community services we found:

  • The services planned and provided services in a way that mostly met the needs of local people.
  • The services took account of patients’ individual needs. The services had taken steps to ensure vulnerable people were supported to use the service.
  • The services treated concerns and complaints seriously, investigated them and learned lessons from the results, which were shared with all staff.

However,

  • Commissioning arrangements resulted in level of some services provided to children, young people and families differed depending on their home address and the location of some services did not fully meet the needs of the local population.
  • There was no assurance that due to increase in the numbers of Looked after Children that all looked after children would receive health reviews that met the national guidance.
  • Access to translation services was more limited in some geographical areas of the services.
  • According to the trust’s information, people who they were caring for did not always have timely access to initial assessment, test results, diagnosis, and treatment.

In mental health services we found that:

  • Complaints were investigated by the trust and appropriate action was taken. Outcomes from investigations where complaints had been made were thorough and feedback about actions was provided to complainants.
  • Patients had access to facilities to help meet their needs. These included rooms for activities, lounges, secure storage in their rooms and access to outdoor space.
  • The trust had access to translation services for patients that did not speak English as a first language. Staff could request meals to meet dietary and cultural needs.
  • There was information available about patients’ rights, advocacy, local services and medication for patients. Staff could provide information in easy read and a variety of languages if needed.
  • Staff made reasonable adjustments for patients with accessibility needs.
  • Staff supported patients to access the wider community. This was done through escorted and unescorted leave. Local voluntary agencies attended the wards to engage in educational and training opportunities for the patients.

However,

  • Patients could only make a private telephone call if they had their own mobile telephone on the older people’s wards.
  • There was no system in place that recorded when there was no health-based place of safety available to patients and patients had to be taken by the police to the local emergency department.

Well-led

Good

Updated 27 February 2019

Our rating of well-led improved. We rated it as good because:

In community services we found that:

  • The trust had managers at all levels with the right skills and abilities to run a service providing high-quality sustainable care.
  • The trust had a vision for what it wanted to achieve.
  • Managers across the trust promoted a positive culture that supported and valued staff, treating a sense of common purpose based on shared values.
  • Community teams had effective systems for identifying risks, planning to eliminate or reduce them, and coping with both the expected and unexpected, including winter plans.
  • Community team collected, analysed, managed and used information well to support all its activities, using secure electronic systems with security safeguards.
  • Community teams engaged with patients, staff, the public and local organisations to plan and manage appropriate services, and collaborated with partner organisations effectively.
  • Community teams were committed to improving services by learning from when things went well and when they went wrong, promoting training, research and innovation.

However,

  • Most staff were not aware of the freedom to speak up guardian role. Most staff had a lack of understanding about their responsibilities towards the duty of candour legislation.
  • Although the service had systems for identifying risks, not all risks were formally identified which meant there was no plan to eliminate or reduce them and there was no assurance senior management were made aware of these risks.

In mental health services we found:

  • All staff understood the trust’s vision and values and how they related to their work place. There was an open culture and team morale in the majority of services was high. Staff told us they were proud to work for the trust.
  • Staff told us in all services local leadership was strong and supportive. Staff felt valued. Staff told use senior leaders in the trust were visible and approachable.
  • Staff felt able to raise concerns and that they would be listened to.
  • The majority of services had good governance systems in place to ensure that managers had access to up to date performance data. This helped them to monitor and improve performance on the ward.
  • Staff had embraced quality improvement programmes to help improve the services they worked in.
  • Mental health teams were committed to improving services and learning from incidents and complaints to improve services.
Checks on specific services

Community mental health services with learning disabilities or autism

Outstanding

Updated 15 November 2016

We rated community mental health services for people with learning disabilities as outstanding because:

  • Staff truly respected and valued service users as individuals and aimed to empower them to achieve what they wanted to. All staff had a focus on the individual in what they did, with an ethos of enabling service users'. The service was focussed on the needs of the people using it and valued their participation in their care. Leadership within the service drove a positive, valuing and learning culture that staff thrived in.

  • The service was innovative in developing new approaches to care and was responsive to the needs of service users. These were developed collaboratively with people using the service.

  • Capacity and consent were carefully considered in all interventions. Interventions followed best practice guidance and latest research which the service regularly reviewed.
  • Governance arrangements were exemplary. The service had excellent learning from complaints and incidents The service continually reviewed best practice and national guidance and how it could be applied to the service. The service worked hard to gain feedback from people using the services in different ways and then acted on it.

Mental health crisis services and health-based places of safety

Good

Updated 27 February 2019

Our rating of this service stayed the same. We rated it as good because:

  • There were robust systems in place to keep staff safe, including personal alarms. All staff knew how to report incidents on the electronic system and made safeguarding referrals as needed. The teams learnt from incidents and could show changes they had made to prevent similar incidents happening. Staff assessed and reviewed patient risk regularly.
  • Staff completed assessments promptly after admission and developed treatment plans that were recovery focused. The teams followed national guidance and the crisis team offered appropriate psychological therapies.
  • Staff were compassionate towards patients. Patients and carers were involved in decisions about their care and the development of the service. Staff signposted patients to other services that could support them and encouraged families to have carers assessments.
  • Staff in the crisis team offered appointment times to suit patients, were flexible and actively worked to engage with patients. The teams worked to meet patients’ needs; offering food and lifts home to patients.
  • Managers were supportive, approachable and encouraged staff to review and improve their practice. The teams’ vision reflected the trust’s values. Senior trust managers supported the development of team manger’s leadership skills. Team leaders encouraged staff to work towards improving quality. There were effective governance systems in place and managers acted to address any identified concerns.

However:

  • The crisis team had low compliance with mandatory training and the manager did not keep a record of safeguarding referrals made by the team. The health-based place of safety did not follow the trust’s seclusion pathway.
  • The crisis team’s care plans were not always up to date.
  • Managers did not monitor when there was no health-based place of safety available to patients.

Community health services for adults

Good

Updated 27 February 2019

Our rating of this service stayed the same. We rated it as good because:

  • The service had enough medical and nursing staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment
  • Staff kept detailed electronic records of patients’ care and treatment. Records were clear, up-to-date and easily available to all staff providing care.
  • Community adults planned and provided services in a way that met the needs of local people. Services were delivered, made accessible and coordinated to take account of and meet the needs of different people, including those people in vulnerable circumstances.
  • There was effective multidisciplinary working both across the community adults and with partner organisations. Staff of different kinds worked together as a team to benefit patients. Doctors, nurses and other healthcare and social care professionals supported each other to provide good care
  • The service treated concerns and complaints seriously, investigated them and learned lessons from the results, and shared these with all staff.

However,

  • Equipment was not always available in a timely way. Patients were subject to significant delays in the provision of or repairs to wheelchairs, which affected the safety and well-being of many patients receiving adult community services. Ordering procedures resulted in delays of equipment for some patients.
  • While the service provided mandatory training in key skills for all staff the figures provided by the trust indicated that staff were not completing their training and were not compliant with statutory and mandatory training targets set by the trust.
  • Staff we interviewed understood how to protect patients from abuse. The service provided staff with training on how to recognise and report abuse however,the data provided by the trust indicated that staff were not completing their training and were not compliant with statutory and mandatory training targets.

Community-based mental health services for older people

Good

Updated 27 February 2019

Our rating of this service improved. We rated it as good because:

  • All environments we visited were clean and comfortable. The team base had disabled access and toilets. Appropriate equipment was available to staff and regular checks were in place.
  • All patients had high quality care plans in place with well documented patient and carer involvement. There was regular assessment of mental and physical health needs.
  • Patients and carers told us they were happy with the care they received from the team.
  • The team was proactive in its approach to quality improvement and undertook regular audits to ensure quality of care. The team was also involved in quality improvement projects.
  • There was a proactive approach to managing risk. Each patient had a high-quality risk assessment and the team held weekly risk meetings.
  • There was evidence of good leadership within the team. The manager was visible and supportive and created a positive culture with good staff morale.

However;

  • Ligature points identified in a risk assessment did not feature on the risk register. There was no mitigation in place for the ligature points which meant that staff may not be aware if a patient tied a ligature.
  • Staff did not offer independent mental health advocates or independent mental capacity advocates to patients.
  • There was no access to neuropsychology for patients.
  • There was no clear discharge procedure or maximum caseload size for the memory monitoring service. This caseload number could potentially become risky in the future unless staffing levels are closely managed.

Community health services for children, young people and families

Good

Updated 27 February 2019

Our rating of this service improved. We rated it as good because:

  • Children, young people and families were protected from poor care and abuse by staff who had the relevant skills and received appropriate support. This was by mandatory training, safeguarding awareness, competency assessments, supervision and appraisals. Where there were staff shortages the service took mitigating actions to reduce the level of risk to patients.
  • The service had a culture of learning from where things had gone wrong, this included learning from incidents and complaints.
  • The service mostly provided care and treatment based on national guidance. Staff followed processes to ensure management of medicines was carried out in a sure way that met national guidance.
  • There was effective multidisciplinary working both across the trust and with partner organisations.
  • The leadership of the service supported monitoring and improvements to the services they delivered. The service engaged well with patients, partner organisations and staff. Staff reported a supportive working environment that looked after their wellbeing as well as supporting them in their personal career development.

However,

  • Equipment was not always available in a timely way. Children and young people were subject to delays with the provision of or repairs to wheelchairs. Ordering procedures resulted in delays of equipment for some children.
  • Electronic recording systems could not provide assurance about staff completion of mandatory training.
  • Health visiting performance was below the national average
  • Although the service had systems for identifying risks, not all risks were formally identified which meant there was no plan to eliminate or reduce them.
  • Staff had limited understanding about the Freedom to Speak up Guardian role and their responsibilities towards the Duty of Candour legislation.

Acute wards for adults of working age and psychiatric intensive care units

Good

Updated 27 February 2019

  • Staff treated patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness.
  • The managers across all teams ensured that staff had access to regular team meetings to share information and develop learning.
  • The managers promoted a positive culture that supported and valued staff.
  • Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support.

  • Staff told us that they learn from incidents on the ward and hold regular debriefs Staff received feedback for investigations of incidents through individual supervision.

However;

  • The service did not ensure that the management of patient’s medicines was safe.

  • The governance systems in relation to prescribing and medicine management did not pick up polypharmacy (many medications) prescribing for patients that may be detrimental to their health and wellbeing. They did not also pick up or patients on doses of medications that were higher than the recommended in BNF (British National Formulary that provides advise on prescribing and pharmacology).

Wards for older people with mental health problems

Good

Updated 27 February 2019

Our rating of this service improved. We rated it as good because:

  • Staff assessed and managed risk well. Staff regularly risk assessed the care environment and gave strong consideration to observation of patients, potential ligature points and blind spots. Staff worked to reduce incidents on the ward including falls. Staff communicated information relating to risk effectively to the oncoming shift and wider multidisciplinary team. Staff made safeguarding referrals when incidents met the safeguarding threshold.
  • Staff monitored patients’ physical health. Staff used a range of tools and scales to assess and review patients’ physical well-being. Staff supported patients to live healthier lives through education and well-being groups. Care records were mostly detailed, holistic and person centred.
  • The trust had invested in creating a dementia friendly environment. Doors and walls had been painted with appropriate colours. There was pictorial signage with wording on doors and there was an orientation board for patients in communal areas.
  • Staff received an effective induction and supernumerary period. Managers supervised staff and completed a yearly appraisal. Staff were encouraged to professionally develop and had access to additional internal or external training courses.
  • Staff complied with the Mental Health Act and Mental Capacity Act. Detained patients received their rights in line with trust policy and were written up for section 17 leave. Staff assessed patients’ mental capacity when there was doubt about their capacity to make a particular decision and made applications to the local authority to deprive patients of their liberty under the Deprivation of Liberty Safeguards when necessary. Staff had support and advice from the Mental Health Act administrator within the trust for issues relating to the Mental Health Act and Mental Capacity Act.
  • Patients said staff were kind to them and treated them with dignity and respect. Patients were well orientated to the ward environment. Patients felt involved in their care.
  • Patients were respected and valued as individuals and empowered as partners in their care.
  • Patients were active partners and felt involved in their care. Staff were committed to working in partnership with people.
  • Patients emotional and social needs were highly valued by staff and were embedded in their care and treatment.
  • There was strong leadership on the ward and staff felt senior leaders were visible and approachable. Staff felt valued and respected and the trust supported them to develop within their role.

However:

  • Patients did not receive psychological treatments to meet their needs. A psychologist had been employed by the trust but had not yet started. Patients who needed psychological therapy were referred to improving access to psychological therapies (IAPT) or supported by the occupational therapists with low level therapies such as mindfulness and breathing exercises.
  • The local ligature audit did not update staff on the actions that had been taken to reduce ligature risks.
  • Sterile equipment was not managed safely as we found a number of products that had dates expired.
  • Capacity to consent to restrictive interventions such as bed sensors and sensor mats were not clearly recorded on the new care panning system.
  • Patients could only make a private telephone call if they had their own mobile telephone. Patients could access the ward phone but had to do this under supervision.

Long stay or rehabilitation mental health wards for working age adults

Good

Updated 27 February 2019

Our rating of this service stayed the same. We rated it as good because:

  • Staff had built good relationships with patients. Staff gave patients information about the service and what treatments were available. The information was provided in a number of formats and was available to patients and upon their request at any later date.
  • The service had regular fortnightly ward rounds that focused on multi-disciplinary and multi-agency working. There had been recruitment on the ward to improve staffing numbers since our last inspection in 2016. New staff were provided with induction and a personal development program with regular reviews with managers and supervisors.
  • The ward used regular bank and agency staff to cover sickness and vacancies. These shifts were block booked ahead with same bank or agency staff to provide continuity of care and familiarity for patients.
  • Staff assessed the needs of patients. Assessments were comprehensive and updated regularly in fortnightly reviews.
  • Patient care plans were holistic and patient centred. Staff sought patients` views and involvement in their care plans.

  • Staff assessed and managed physical health through weekly monitoring.
  • Staff carried out risk assessments of the care environment. The team risk register included a comprehensive record of environmental risks and how they were mitigated.
  • Staff completed a comprehensive risk assessment for all patients on admission and updated them regularly in fortnightly multi-disciplinary meetings.
  • Patients said that staff were kind and caring. They said they felt safe on the ward.
  • Staff had access to services in the trust and external services to help meet patients’ needs. These included regular visits by an independent advocacy service.
  • Staff understood and knew when to report safeguarding. Staff were familiar with and followed the trust’s safeguarding policy.
  • There was good leadership from the ward manager, the modern matron and the ward psychiatrist.

However:

  • Provision of psychological therapies and intervention were limited. For example, specialised risk assessment such Historical, Clinical, Risk Management-20 (HCR-20) which were usually completed by the psychologist were not always done for patients who required these specific risk assessments.
  • Staff supervision was not documented and recorded every month in line with trust policy.
  • Staff appraisals were not documented and recorded yearly in line with trust policy.
  • Staff did not routinely check T2 and T3 forms when administrating prescribed medicines.
  • Sterile equipment was not managed safely as we found a number of products that had passed their expiry date.

Substance misuse services

Good

Updated 5 September 2017

We rated Solent NHS trust substance misuse services good overall because:

  • During this inspection, we found that the services had addressed the issues that had caused us to rate safe as inadequate and effective, responsive and well-led as requires improvement following the June 2016 inspection.

  • The substance misuse services were now meeting Regulations 9, 12, and 17 and of the Health and Social Care Act (regulated activities) Regulations 2014.

  • Staff ensured that they reviewed prescriptions regularly. There were clear policies in place identifying individual responsibilities and that all clients had a prescribing care plan in place. Both services had signed Patient Group Directions (PGDs) for Hepatitis B injections.

  • Staff were supported to monitor and manage caseloads safely and effectively and there were sufficient staffing levels to safely manage and review clients in receipt of prescriptions.

  • Staff had carried out necessary home visits for clients on prescribed medication and who had children. The services had an embedded process in place to monitor this.

  • Managers ensured the trust risk register reflected all identified service risk issues.

  • Staff ensured they discussed discharge plans for all clients who accessed the service, and there were clear protocols in place for those who regularly did not attend appointments or disengaged from the service.

  • There was clear and visible leadership and oversight across both services. Managers ensured staff attended mandatory training and received supervision and appraisals. Local and senior managers worked together to ensure the staff were supported in their roles to achieve positive outcomes.

Specialist community mental health services for children and young people

Good

Updated 5 September 2017

We rated specialist community mental health services for children and young people as good overall because:

  • By the time of this inspection, the services had completed the actions we required it to take following the inspection in June 2016. The specialist community mental health services for children and young people were now meeting Regulations 9, 12 and 17 of the Health and Social Care Act (Regulated Activities) Regulations 2014.

  • Staff understood how to assess and manage the risk to young people. Clinicians in the service had designed a new bespoke risk assessment appropriate to young people’s needs. All young people had a risk assessment and staff completed risk management plans if it was appropriate to do so. Managers had made adjustments to manage environmental risks in the team bases. Staff understood how to make safeguarding referrals and felt confident to do so.

  • Staff completed care plans to support the safe and effective care of young people on their caseload. Staff had received appropriate training to enable them to assess young people and work with those on their caseload.

  • Staff demonstrated empathy, kindness and caring when working with young people. Staff actively encouraged young people and their carers to be engaged in making plans of care and to provide feedback on the service they received. This included training for young people to interview new staff. Staff were highly motivated and offered care that is kind and promotes young people’s independence. We rated caring as outstanding.

  • There were robust governance structures in place to ensure the quality and safety of the care young people received. We saw closer working relationships between the teams in Southampton and Portsmouth. This ensured consistency in the delivery of care with teams sharing ideas and training opportunities.

However:

  • We found that waiting list times between assessment and receiving treatment were still long. However, the trust had made changes and recruited more staff to reduce these as quickly as possible.

  • Staff in Southampton did not routinely record capacity or consent in an easily accessible manner. None of the 20 records in Southampton had it recorded. In Portsmouth, all records had a form that recorded consent and considered Gillick capacity. The trust confirmed that they would implement this form in Southampton when we raised this with them.

Community health inpatient services

Good

Updated 15 November 2016

Staff understood their responsibilities to raise concerns and report incidents, and evidence learning occurred as a result. Staffing levels were sufficient to provide safe care. The trust employed regular agency and bank staff to mitigate risks to patients when wards were short of staff. Risks to patients were monitored, and arrangement were in place and followed access to medical advice and support when needed.

Staff provided care and treatment that took account of nationally recognised evidence based guidelines and standards. Patient pain was managed effectively, and patient’s varied dietary and nutritional needs were met. The trust took part in national and local audits to measure and promote improved outcomes for patients. Staff had a good understanding of their responsibilities to the Mental Capacity Act and applied it appropriately when caring for patients who had reduced capacity and cognition. There was a strong emphasis on multidisciplinary working across all inpatient wards.

Nursing and medical staff were caring, compassionate and patient centred in their approach. We observed staff maintained patient’s respect and dignity at all times. Patients were involved in making decisions about their care and treatment.

Admission criteria supported patients to be admitted to the ward that met their individual needs. There was evidence the trust used learning from complaints to improve the quality of care.

There was a clear governance framework to monitor quality, performance and risk at ward level. Staff knew the risks and mitigating actions for their individual wards. Staff felt respected and valued by their immediate and senior managers.

However:

The admission criteria for Spinnaker ward was not always adhered to. Staff told us that at times the local acute trust overruled the admission criteria and sent patients to Spinnaker ward before assessments were completed. Difficulties in accessing social care services resulted in delayed discharged from the wards. Some wards had difficulties in accessing interpreting services, which affected the care and treatment patients received.  On some wards medicines were not always stored at the correct temperature: this had the potential to reduce the effectiveness of medicines.

End of life care

Good

Updated 15 November 2016

Overall rating for this core service

End of life care services at this trust was rated as good overall.

  • Safety was rated as good. Patients were protected from avoidable harm; staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses and arrangements to minimise risks to patients were in place. Patients were protected from abuse. Staff had an understanding of how to protect patients from abuse, could describe what safeguarding was, and the process to follow if they suspected a patient was at risk of avoidable harm or abuse.

  • We rated the effectiveness of this service as good. Patients received effective care and treatment that took account of current evidence-based guidance, standards and best practice. Patients had a comprehensive assessment of their needs, which included pain management, nutrition and hydration, and physical and emotional aspects of their care.

  • Care from a range of different staff, teams and services was co-ordinated effectively. There was effective multidisciplinary working, with staff, teams and services at this trust and external organisations working in partnership to deliver effective care and treatment.

  • Staff understood the relevant consent and decision making requirements of legislation and guidance, including the Mental Capacity Act 2005; this was reflected in the ‘Do Not Attempt Cardio Pulmonary Resuscitation’ (DNACPR) orders reviewed during our inspection.

  • The care provided to patients in end of life care services was good. Patients were truly respected and valued as individuals and were empowered partners in their care. Feedback from patients, relatives and carers was consistently positive and there were many examples of staff going ‘above and beyond’ when delivering care.

  • We found the responsiveness of end of life care services to be good. Patient’s needs were mostly met through the way end of life care was organised and delivered. However, the rapid discharge of those patients expressing a wish to die at home was not monitored. We could not therefore be assured this was happening in a timely way.

  • We found the leadership of end of life care services was good . This was an evolving service which had diffently commissioned service models across the two cities it served (Portsmouth and Southampton). There was a strong vision and a strong focus on patient-centred care. There were robust mechanisms in place to share learning locally across end of life care services.

Community health sexual health services

Good

Updated 15 November 2016

Overall rating for this core service Good

We rated sexual health services as good because:

Staffing levels and skill mix were planned, implemented and reviewed by the matrons to meet the level of need for the service/ needs of patients. All staff including bank staff were provided with induction, including competencies, to ensure they could safely and effectively undertake their role.

Where patients received care from a range of different staff, teams or services this was co-ordinated. All relevant staff, teams and services were involved in assessing, planning and delivering patients care and treatment. Staff worked collaboratively to understand and meet the range and complexity of patients’ needs.

Feedback from patients who used the service and other stakeholders was positive about the way staff cared for them. Staff treated patients with dignity and respect, and patients told us they felt supported and said staff cared about them.

Evidence based practice was being followed for care and treatment. Patients had appropriate and timely notifications but there were delays in the diagnosis time for Chlamydia patients and for testing times for children with HIV parents.

Services were planned in a way that met the needs of the local population. The importance of flexibility, choice and continuity of care was reflected in the services. The needs of all patients were taken into account when planning and delivering services. For example, the trust provided clinics for young people at locations and times when they could access them. Patients were offered appointments within 48 hours.

Information and data were used proactively to identify opportunities to drive improvements in care, for example, same day access clinics. Service changes were developed with input from doctors, nurses and patients who used the service, to understand their impact on the quality of patient care.

There was a culture of continuous learning, and sharing knowledge nationally, to achieve good patient outcomes.

Since the last inspection of the service in March 2014, there have been improvements in timely access to the clinics. This has included same day access clinics. Patients were now not being turned away from clinics without being assessed and prioritised, and given a plan that took account of their sexual health needs. Although delays meant some patients did not wait for treatment.

Community-based mental health services for adults of working age

Good

Updated 15 November 2016

We rated community-based mental health services for adults of working age as good because:

  • Managers were aware of staff caseloads and adjustments were made to take account of the complexity of patients. Recovery teams were piloting a case load tool which looks at risks, care coordination and time spent on cases, assigning scores of one to five depending on seriousness of risk.

  • Patients who required regular blood checks to ensure maintenance of therapeutic levels of medicines and to detect any signs of serious side-effects, attended clinics run by the “wellbeing” staff. The trust had introduced point of care haematology testing for clozapine.

  • Care records we reviewed showed care plans were up to date, personalised, holistic, recovery orientated and included evidence of ongoing physical care, informed consent and appropriate consideration of mental capacity.

  • Staff had a very good understanding of the needs of their individual patients. Staff were committed to patient care and care was patient centred. Staff were responsive to patients’ needs and able to demonstrate how they could draw on increased support from colleagues if required.

  • There were clear care pathways dealing with access and discharge to the community teams.

  • Staff were overwhelmingly positive about the culture of the teams which they described as mature, supportive and very open. They also felt supported by line managers and colleagues.

However,

  • The Trust should within the main base of the community mental health teams risk assess the three interview rooms which are L shaped. This is because when staff were sat at the desk with patients, they could not be observed through the door.

  • The Trust should consider providing prevention of violence and aggression or breakaway techniques training for staff.