Essex Partnership University NHS Foundation Trust

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

At our last inspection, we rated this key question as inadequate. Following this inspection, the rating had improved to requires improvement. We found one breach of the legal regulations in relation to good governance where there continued to be gaps in the management and support arrangements for staff, as identified in the previous inspection. For 4 wards, Ardleigh, Cherrydown, Christopher Unit and Hadleigh supervision rates ranged between 53% to 74% and for 2 wards Ardleigh and Cherrydown ward, appraisal rates were 65% and below.

We also found there continued to be evidence of systems and processes not always being used safely to prescribe, administer and record medicines which resulted in a breach in safe care and treatment.

However, staff knew the trust’s visions and values and were involved in the development and ongoing review of these. Staff and leaders ensured any risks to delivering the strategy, including relevant local factors, were understood and had an action plan to address them. They monitored and reviewed progress against delivery of the strategy and relevant local plans. Leaders were knowledgeable about issues and priorities for the quality of services and could access appropriate support and development in their role. Duty of Candour records showed the trust were open and honest with patients and relatives. The trust had policies in place that were in line with best practice guidance. Staff said they felt able to speak up and were listened to and where there was learning this was shared amongst staff. Despite the oversight of medicines and staff support, governance processes mostly operated effectively, and performance and risk were managed well. The trust promoted workforce equality, diversity and inclusion and worked with partners and communities. There were processes in place to ensure that learning happened when things went wrong, and from examples of good practice. Leaders encouraged reflection and collective problem solving.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff were able to explain what the visions and values of the trust were and how they applied to their role, staff said the visions and values were discussed regularly in meetings and supervisions and they were able to give feedback on these. Staff said they felt respected, valued and supported.

Leaders were aware of any risks to delivering their strategy and had local action plans to address these that they monitored and reviewed for progress.

The trust had developed a quality of care strategy which they planned to embed between 2024 and 2026. The emphasis of this strategy was to focus on quality through safety, experience and effectiveness using patients lived experience of care. The trust implemented the time to care model based on learning from the past and guidance for best practice. This included a new staffing model to broaden the skills in teams and a focus on purposeful admissions and discharges. This also focused on training and development in trauma-informed care, racial-equity and autism. Staff had fedback some concerns about this model and approach to care. The trust had put measures in place to support staff with these changes and were working at ways to engage staff in this process.

Staff felt supported by managers and told us the overall culture of the service had improved since the last inspection. Managers described how changes to the structure of management had made a positive impact in allowing better oversight and scrutiny. Leaders were visible within the service and had the experience, capacity, capability, and integrity to ensure that the organisational vision could be delivered, and risks were well managed.Staff spoke positively about the introduction of the clinical site managers to support the wards out of hours and at weekends.

Managers had developed and embedded a protocol to check staff were not sleeping on duty at night. This protocol was introduced along with the clinical site officers. This followed the previous inspection where we raised concerns in relation to staff sleeping at night. We also had feedback from some patients during this inspection that there were instances of staff sleeping when they should be undertaking observations. Managers had embedded this protocol to minimise this. Interventions included reducing patient observations to 30 minutes instead of an hour from midnight until the day shift, 30 minute well-being checks of staff on day and night shifts and the implementation of the site officer who checked allocation of tasks, ensuring staff were getting the correct breaks, doing walk rounds, offering breaks and drinks.

Staff were aware of the term ‘freedom to speak’ and what this meant, however, not all staff knew who the trusts freedom to speak up guardians were, but they were able to explain how they would access freedom to speak up information if they needed it. Staff said they felt able to speak up and were listened to and where there was learning this was shared amongst staff.

The trust had policies in place that were in line with best practice guidance for freedom to speak up, whistleblowing and complaints. Between September and December 2024 there had been 9 whistleblower complaints across the 9 wards we visited, the themes were team culture, staffing levels and staff conditions. Staff were given the opportunity to speak up and drive improvement through staff surveys, supervisions and meetings.

The trust used a scoring system to evaluate inpatient staff survey results. Results showed that out of 364 staff respondents, the trust received a score of 6.84 out of 10 for ‘we have a voice that counts’. Out of 355 staff responses, the trust scored 7 for staff engagement. Staff also felt ‘recognised and rewarded’ and scored 5.93 out of 10 compared to the overall organisation result of 6.37 out of 10.

Staff told us they had equality champions on wards including Black and Ethnic Minority champions, LGBTQ+, personality disorder and neurodiversity champions. Staff were aware of information available on the intranet relating to equality and diversity and knew where they could access this information. Staff spoke about information from the equality networks being widely publicised and shared with staff across the organisation. Most staff said managers were open and there was a zero tolerance to bullying or harassment.

Staff spoke about the Resilience, Intelligence, Strength and Excellence (RISE) programme, a talent development programme aimed to improve Workforce Race Equality Standard (WRES) indicators. The programme was targeted towards Black and Ethnic Minority staff to enhance their career progression.

Staff undertook diversity and inclusion training annually.

The trust had a workforce race equality standard action plan (2024- 2025) and a workforce disability action plan (2024-2025) where all indicators were reviewed and updated to ensure progress had been made. The trust had made a commitment to embed the Patient Care Race Equality Framework (PCREF) to involve patients and carers in decisions of care, treatment and policy making. PCREF is designed to ensure racialized communities have fairer access to services, improved outcomes and better experiences of services.

The trust had 5 staff equality networks including Ethnic Minority and Race Equality, Gender Equality, LGBTQ+, Disability and Mental Health, Faith and Spirituality where members worked with the trust to understand the needs of the communities and shape improvements. The trust held the Equality and Inclusion Committee which was embedded into their governance process. Feedback from staff, patient surveys, equality networks and data from the Workforce Race Equality Standards (WRES) and Workforce Disability Equality Standard (WDES) were used to inform trends and make improvements.

Leaders had taken action to review and improve the culture of the organisation in the context of equality, diversity and inclusion. Leaders had ensured reporting of racial abuse against staff was prioritised. This was an area highlighted at the previous inspection where not all staff said they would report this. Managers had added the category of racial abuse to the incident reporting system so that staff were able to report racial abuse and this was monitored. Data showed that reporting of incidents of racial abuse had increased by 244% where 82 incidents were recorded between 1 April 2022 and 31 December 2022. This rose to 279 between 1 April 2023 and 31 December 2023.

Staff said they had regular team meetings, situation report meetings to discuss any issues or risks, multi-disciplinary team meetings, attended safety huddles, received regular lesson learned information and understood their roles. Most staff felt the wards were well organised and managed. Staff were able to give examples of the checks they had participated in to ensure the safety of the wards such as security checks, observations, audits and checks of equipment. Staff feedback that they received regular supervision and appraisals, however, supervision and appraisal rates remained low for some wards.

Leaders explained how they communicated and interacted with staff to ensure they managed risk and sought staff views to make improvements. Leaders spoke about their responsibilities in relation to maintaining oversight of the services, by being present and ensuring they had managers and matrons on site. Managers spoke about having oversight of capacity, budgets, audits, performance, key performance indicators and incident data. They shared clinical dashboards with teams and managers for oversight and review.

The trust did not have sufficient oversight of staff supervision and appraisals and did not ensure systems and processes were being used safely to prescribe, administer and record medicines. These issues were breaches at the previous inspection where the trust held an action plan to address both these areas. However, this was not currently active, so they did not remain an area of focus by managers. Further work was required to ensure governance systems were fully embedded.

However, there were regular governance meetings for safety, audit, quality and governance. The trust discussed and addressed key areas of performance, risk, audit, culture and workforce. Minutes showed areas of concern were identified and actions were taken to learn and improve.

The trust held a risk register for inpatient and urgent care which we reviewed for December 2024. All risks were identified with risk scores, controls, mitigations with assurance and action review dates. The highest risk related to the use of inappropriate out of area placements which was rated as extreme, and bed availability was rated as high. Leaders said staff could make suggestions to add to the risk register which would be escalated to the quality assurance meeting.

The trust had made efforts to improve the quality of and the culture of care delivered across the organisation by implementing the Quality of Care Strategy and the Time to Care model. These focused on improving the quality and safety on wards with a focus on co-production and improving the staffing levels.

Staff knew how to deal with complaints and reported incidents and safeguarding concerns. Managers shared lessons learned from investigating complaints, incidents and safeguarding issues. Following the previous inspection, the trust had made improvements in relation to learning from incidents and to improve safety. The trust reviewed deaths and patient safety inquests, but they were still working on embedding this to ensure a formalised process was in place to include inquest outcomes and associated learning was jointly reviewed.

Patients we spoke with talked about using leave to access the local community and community facilities. Some patients raised frustrations about delays to discharges and that they needed more support with transitioning back into the community for areas to do with employment and housing.

Staff invited family members and external professionals to meetings so they could discuss any issues and receive any updates about their patient's / family member's care and treatment. Patients that we spoke with told us they were able to give feedback on how to improve the service they received.

The trust had 5 staff equality networks including Ethnic Minority and Race Equality, Gender Equality, LGBTQ+, Disability and Mental Health, Faith and Spirituality where the trust worked with members to understand the needs of the communities and shape improvements.

Staff had access to regular team meetings on the wards. Staff were able to propose, exchange and discuss ideas in terms of good practice. Staff could attend reflective practice sessions facilitated by the psychology department.

Staff told us that they completed mandatory training and were encouraged to engage in training that was in addition to their required training. They shared learning within team meetings, team debriefs and within reflective sessions.

Integrated Care Boards told us they worked with the trust through various forums focusing on quality, safety and performance. Integrated Care Board members felt that the trust’s staff and leaders were open and approachable, and they worked well together to address operational needs.

The trust held a monthly trust wide meeting with Essex police where they engaged on issues and worked well together to form solutions. The trust had contacts with the police and were able to contact them quickly if they needed to.

The trust worked with integrated care board members and worked in partnership with housing providers, social care providers and other healthcare organisations to facilitate discharges of patients from the service.

The trust had appropriate governance processes in place to support effective links with the community and with partners. The trust sought feedback from staff, patients and carers through surveys and used this feedback to make improvements.

Staff that we spoke with said managers listened and considered any ideas staff shared with them for improving the service or about concerns around patient care.

Leaders told us about a project on Peter Bruff ward where an anti-ligature and anti-barricade alert called ‘Safe Hinge’ on doors was being trialled. The system was designed for mental health environments to reduce the risk of ligatures and barricading and included a full door alarm to alert staff of any ligaturing or barricading attempts on doors. The trust were trialling this in one bedroom.

Staff told us about a quality improvement project on Cherrydown ward to support staff, so they did not sleep on shift at night. Staff developed a protocol on this which was shared across the trust. The protocol included reducing staff observations of patients from 1 hour to 30 minutes.

Stort ward conducted a quality improvement project, where the aim was to reduce the use of seclusion by 15% by December 2024, which was achieved. This included the team working through a number of change ideas evaluating how these impacted on reducing restrictive practice on the ward. The ward presented their findings so that their learning could be shared.

Staff received training across the trust on culture of care sessions covering trauma-informed care, racial-equity and autism.

Basildon Mental Health Urgent Care Department were nominated for the NHS parliamentary awards for excellence in urgent care and were one of the finalists.

Staff spoke about receiving regular incident themed learning emails so that they were aware of the themes and learning from incidents in their areas.

The trust had a process in place where they met regularly to review learning from deaths. The trust were still in the process of fully embedding this. The trust had various meetings in place to ensure that safety, quality, performance, improvements and learning were actioned and reviewed.

The trust had made a commitment to embed the Patient Care Race Equality Framework (PCREF) to involve patients and carers in decisions of care, treatment and policy making. The Linden Centre were involved in piloting this piece of work.

Senior leaders spoke about launching a new quality strategy in January 2024 which runs to 2028. This had been co-produced and had key objectives related to safety, effectiveness and experience and included end of life care, neurodiversity and health inequalities.

The trust worked on reducing complaints for the last two years where they completed a co-produced quality improvement project to improve the complaints process. The trust saw a 30% reduction in formal complaints.

The trust were involved in a discrimination and violence pilot where a racial abuse scrutiny panel took place at Basildon police station. The aim of the panel was to ensure that the outcomes of hate crimes involving NHS staff were appropriate and addressed the barriers to reporting these and to maximise the trust and confidence that NHS staff have in the police. As a result, a number of investigations had been reopened, police committed to being more visible, a joint action plan was developed, and further meetings were planned with the police.

The trust embedded a new records system to ensure all teams could access and were using the same system. The trust also rolled out a new electronic prescribing and medicines administration system for prescribing, ordering, administering and recording medicines.

The trust had key quality of care governance priorities for 2024 and 2025 that included a plan for each quarter. The priorities included 3 main areas including safety, focusing on reducing restrictive practice, infection prevention control and safeguarding. Secondly, effectiveness, specifically focusing on improving physical health, suicide prevention and medicines optimisation and lastly experience, with a focus on reducing health inequalities, promoting neurodiversity and end of life care. This work was still on-going.

The trust reviewed quality improvement projects in their inpatient quality and safety committee meetings. These included patient case studies on inquest learning and long term segregation. The trust noted a reduction in seclusion and long term segregation, self-harm and ligatures for the last two months in September 24.