Somerset NHS Foundation Trust

Updated 23 January 2023

Somerset NHS Foundation Trust (SFT) is the first NHS trust on the English mainland to provide community, mental health, and acute hospital services. The trust was formed with the formal merger of Somerset Partnership NHS Foundation Trust and Taunton and Somerset NHS Foundation Trust which took place on 1 April 2020. At our last comprehensive inspection of the Taunton and Somerset trust in January 2020 (the report published in March 2020) we rated the trust overall as good, with a requires improvement rating for safe. Caring was rated as outstanding. The other key questions of effective, responsive well led were rated as good. At our last comprehensive inspection of Somerset Partnership in October 2018 (published in January 2019) we rated the trust overall as good, with a requires improvement rating for safe. Effective, caring responsive and well led were rated as good.

The trust is working towards a planned merger with Yeovil District Hospital NHS Foundation Trust (YDH) to bring the trusts together to create a new, single organisation which will be responsible for running Yeovil District Hospital and Musgrove Park Hospital, the community hospitals in Somerset, all community, mental health and learning disability services in the county with population coverage of 20% of GP practices in Somerset. The two trusts are overseen by a joint board. The merger is due to complete in April 2023.

We carried out this short notice announced inspection of acute wards for adults of working age and psychiatric intensive care unit (PICU), specialist community mental health services for children and young people and community end of life care services of this trust as part of our continual checks on the safety and quality of healthcare services. We also inspected the well-led key question for the trust overall. At our last inspection we rated the trust good overall.

During this inspection we inspected three of the Trust’s core services and rated one outstanding and two as good. We also undertook an inspection of how ‘well-led’ the trust was. We rated the trust as good overall. We rated each of the key questions. We rated safe as requires improvement; effective, responsive, and well-led as good, and we rated caring as outstanding.

The trust provides the following services:

Mental health services

Acute wards for adults of working age and psychiatric intensive care units (PICU's)

Long stay/rehabilitation mental health wards for working age adults

Forensic inpatient / secure wards

Child and adolescent mental health wards

Wards for older people with mental health problems

Community-based mental health services for adults of working age

Mental health crisis services and health-based places of safety

Specialist community mental health services for children and young people

Community-based mental health services for older people

Community mental health services for people with a learning disability or autism

Community health services

Community nursing services or integrated care teams, including district nursing, community matrons and specialist nursing service

Community health services for children, young people and families

Community health inpatient services

Community end of life care

Community dental services

Community sexual health services

Urgent Care

Acute hospital services

Urgent and emergency services

Medical care (including older people's care)

Surgery

Critical care

Maternity

Services for children and young people

End of life care

Outpatients

Our rating of the trust stayed the same. We rated them as good because:

• We rated effective and responsive as good, caring as outstanding and safe as requires improvement. We rated ‘well-led’ for the trust overall as good. In rating the trust, we took into account the existing ratings of the 22 previously inspected services not inspected during this inspection.
• We rated 1 of the 3 core services we inspected as outstanding and 2 as good.
• We rated specialist community mental health services for children and young people as outstanding overall, with caring and responsive rated outstanding. This had improved from the overall rating of requires improvement given at our last inspection. We rated acute wards for adults of working age and psychiatric intensive care units as good. This rating was unchanged since our last inspection. We rated community end-of-life care as good in every domain, this was an improvement as we rated the safe domain as requires improvement at our last inspection.
• During the core services inspections we saw that staff treated people with compassion and kindness, respected their privacy and dignity and understood people’s individual needs. Services were inclusive, took account of patients’ preferences and their individual needs. People had their communication needs met and information was shared in a way that could be understood.
• The strategy provided a focus for the work being done by the trust to prepare for the merger with Yeovil District Hospital NHS Trust and to meet the needs of local populations.
• We found that despite the challenges of the pandemic, the trust had adapted, learnt, and continued to make positive progress. We found that the trust had addressed all the areas where improvements were recommended in the specialist community mental health services for children and young people at the previous inspection. This had a positive impact for people who use services and staff working for the service.
• Staff were well supported by supportive and competent leaders across the organisation. Leaders were well supported with their career development and the provider had improved its approach to succession planning for senior leadership posts.
• We found a positive culture across the trust. Staff told us that they felt proud to work for the trust and we heard many examples of how they put the people who use services at the centre in their work. The senior leaders including the non-executive directors were open, friendly and approachable. They had worked hard during the pandemic to engage with services in person and remotely. People and teams were able to speak honestly and reflect on where improvements were needed and how this could be achieved.
• The non-executive directors provided high quality, effective leadership and delivered support and appropriate challenge to the senior executives. They all had experience as senior leaders in a range of organisations and brought skills from other sectors including NHS acute care, health organisation directorships, social care, education and local government.
• The senior leadership team demonstrated a high level of awareness of the priorities and challenges facing the trust and the local health environment, and how they could address these and influence change in the system. The trust had well embedded clinical leadership.
• The trust’s governance system effectively provided assurance and helped keep patients safe. It helped the organisation deliver its key transformation programmes and priorities outlined in the annual business plan.

However:

• There were still outstanding maintenance, refurbishment and repair issues on acute wards for adults of working age and psychiatric intensive care units to ensure they provided a therapeutic environment. The outstanding issues had been logged on the trust system by staff, but repairs had not been completed. The specific issues are described in the core service reports.

How we carried out the inspection

You can find further information about how we carry out our inspections on our website: www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection.

Before the inspection we reviewed a range of information we held about the services.

During our inspection of the three core services, the inspection teams:

• reviewed records held by the CQC relating to each service
• visited seven wards and ten community team bases across Somerset. We looked at the quality of the ward environments, management of the clinic rooms, and observed how staff were caring for patients
• interviewed the ward manager and/or matron for each ward or service
• reviewed 69 patient care and treatment records
• interviewed 31 patients and 13 relatives of patients
• looked at a range of policies and procedures related to the running of the service
• spoke with the Peer Support worker
• spoke with an independent mental health advocate
• looked at a range of policies, procedures and other documents relating to the running of each service
• spoke with 46 staff members including nurses, clinical practice leads, end of life coordination team, district nursing teams, rapid response service, staff proving care on community inpatient ward. support workers, occupational therapists, occupational therapy students, clinical psychologists, associate psychologists, health care assistants, activities coordinator
• spoke with 18 senior members of staff including the professional lead for the PMVA (Prevention Management of Violence and Aggression) team
• spoke with medical teams across the services including the palliative consultant leadership team, consultant psychiatrists and doctors. We also spoke to members of the LARCH team and End of life education team
• observed eight multi-disciplinary meetings, two home visits and one assessment.

The well led inspection team comprised one executive reviewer who was an executive of an NHS mental health and community health provider, two specialist advisors with professional experience in executive roles and board-level governance, one CQC head of hospital inspection, two CQC inspection managers and three colleagues from NHS England.

What people who use the service say

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

Patients felt safe and their relatives confirmed their family member receiving care and treatment was safe.

Patients knew the reasons for their admission and the conditions of their stay. They knew their rights and how they applied to them. For example, their right to leave.

Relatives felt informed of important events and where appropriate were invited to reviews. Some relatives raised concerns about the closure of St Andrews and how this would impact on their visiting

Patients overall gave positive feedback about the staff and relatives praised staff for their patience. Some relatives had observed staff shortages when they visited. Patients in Rydon 2 said there was a lack of meaningful activities, and the activities room was often closed.

Patients felt confident to approach the staff with complaints and gave us examples of complaints they made with support of their advocates.

Patients knew about their care and treatment but were not provided with copies of their care plan.

Patients knew the routines of the ward and said the meals were of a good standard

Specialist community mental health teams for children and young people

Parents and carers gave very positive feedback about CAMHS (Child and Adolescent Mental Health Services) services. Parents and carers said that every single service responded to them in a timely way, that their children were assessed, and appropriate therapy offered quickly.

Children and young people said their appointments were flexible; they could request a digital appointment and appointments always ran on time.

Parents and carers said that communication was good. They said that staff were supportive, kind, and caring. Parents and carers said that staff always made sure they understood what was happening, they had a very open dialogue with staff and that their opinion was always sought.

Parents and carers said they were reassured by staff and included in reviews and assessments. They said that care plans were done together as a family, and they received written copies regularly.

Young people said they were fully involved in their care and understood what was going on.

Community end of life care

Patients and families knew how to complain and felt they could raise concerns without fear of prejudice.

Patients and families described staff very positively. Some carers had fundraised following the death of patients as they had wanted to give something back to the services that they felt had cared for their loved ones very well.

Patients and families were positive about the support they received from staff, their religious and cultural needs were respected and supported.

Patients and families were supported to give feedback on their treatment and the service.

Updated 1 June 2017

During this inspection, we found that the services had addressed the issues that had caused us to rate safe, effective and well led as requires improvement following the September 2015 inspection. The rating for community health services for adults in caring remains the same as in 2015 (good). Effective, responsive and well-led have all changed from requires improvement to good. Safe has changed from inadequate to requires improvement.

Community health services for adults were now meeting Regulations 9, 17 and 18 of the Health and Social Care Act (regulated Activities) Regulations 2014.

We rated community health services for adults as good because:

• There were effective incident reporting systems in place and staff reported they received feedback and learning from these.
• The duty of candour regulation was understood by staff and we saw evidence which supported this.
• Staff had good knowledge of safeguarding procedures and felt supported in raising any safeguarding concerns.
• Good medicine management protocols were in place to keep patients and staff safe.
• There was access to equipment for clinic settings and for patients in their own homes. We saw equipment was maintained/serviced as required.
• All clinical areas we visited were clean and tidy and free from clutter.
• Staff reported good access to mandatory training.
• In the patient records we reviewed we found in most cases, risk assessments for example, frailty scale, falls risk, malnutrition universal screening tool (MUST), and skin assessments had been completed and reviewed.
• We found multidisciplinary working was embedded in practice across the adult community services.
• The lone working systems in place kept staff safe. Staff were very aware of the policy and adhered to it.
• Patients’ needs were assessed and care and treatment delivered in line with relevant legislation, standards and evidence-based guidance.
• Staff were knowledgeable about assessing patient’s mental capacity and cared for patients in a non-judgemental manner, respecting the rights of individuals.
• Some services collected information about patient outcomes and could demonstrate the effectiveness of their service
• The service participated in national audits, audits requested by commissioners and internal audits. The service used the results to review and improve services
• Staff were qualified and had the skills to carry out their roles effectively. Staff had regular appraisal and supervision, including out of hours and overnight staff.
• Multidisciplinary team working was embedded throughout the service and referrals to different healthcare professionals were coordinated and efficient.
• Consent was obtained for care and treatment interventions in line with policy and guidance.
• Feedback from patients was consistently positive, patients went to great lengths to tell us about their positive experiences.
• We saw patients who were active partners in their care, and were encouraged to give their opinions of their planned treatment.
• Care that we observed was person centred, with patient’s wellbeing at the heart of care.
• Patients received care from staff who treated them with dignity and respect.
• Staff involved patients in exploring their options, and respected the patient’s wishes and requests.
• The needs of patients were taken into account when planning and delivering services. Staff were flexible to meet the needs of patients.
• Reasonable adjustments were made for people with disabilities, learning difficulties and those living in vulnerable circumstances.
• Teams worked very well together to provide the most appropriate care at the most appropriate time for patients.
• Patients were given information about how to make a complaint or raise a concern. There were systems in place to evaluate and investigate complaints.
• Staff were aware of the organisations values and strategy.
• There was strong local leadership in place. Most staff felt able to approach their managers.
• Staff were positive about the executive team and found them visible and approachable.
• There were governance and risk management systems in place.
• There was a positive, supportive culture across all staff groups we spoke with.
• Patients were asked for their views of the service and how it could be improved.
• The trust worked with local commissioners to ensure the needs of the local population were being considered.
• Staff were innovative and worked with external organisations to examine where local improvements could be made.

However:

• The wound assessment tool available on the electronic patient record system was being reviewed by the specialist nurses for tissue viability and the leg ulcer service, district nursing lead and the clinical lead for the electronic patient record system. However we saw inconsistent practice in how wounds were assessed and recorded into paper based documentation in patients homes and on the electronic patient record system.
• Some cupboards used for storing dressings and medicines were not always within the expected temperature ranges. This meant that staff may be using items that were not safe.
• Sharps bins in use were not always labelled with hospital details and specific area in which they were being used. This meant they would not be traceable to an area if there was an issue when being disposed of.
• Not all the emergency trolleys we saw had in date equipment stored on them. In some areas, a systematic check of the trolleys was not documented as having being carried out on a daily basis.
• Not all staff in clinic settings washed their hands between patients or cleaned the examination couch between patients.
• There was not yet an acuity (dependency) tool in place across the trust to enable senior staff to see each team’s dependency ratings and assure staff were deployed to the area’s most in need of help.
• Mobile phone coverage remained patchy meaning staff did not always receive messages in a timely way.
• Staffing levels remained an issue for some teams and specialities. Recruitment was ongoing.
• Community nurses were able to photograph wounds to assess progress or deterioration of wound healing with their current mobile phones. However there were some ongoing issues with information governance and storing photographs on mobile telephones.
• We did not see a corporate chaperone policy. We did see information in patient leaflets and on the organisations website that a chaperone could be requested when attending outpatient facilities.
• Waiting lists for some services were long. Staff had waiting list initiatives in place to reduce waiting times for patients.           

Updated 17 December 2015

Overall rating for this core serviceGood l

Overall community health services for children and young people were found to be good.

Somerset Partnership NHS Foundation Trust provided community services for children, young people and families in Somerset. As part of this inspection we talked to professionals delivering these services. We also met and spoke with children, young people and their parents. We visited services across the county and also spent time on home and school visits with health visitors, school nurses and therapy staff.

Overall we judged the safety of community health services for children and young people as good. Risk was managed and incidents were reported and acted upon with feedback and learning provided to most staff. However, the area for improvement concerned the high vacancy rate in health visiting which presented a risk to capacity and continuity of care.Care was effective. Care was evidence based and followed recognised guidance. There was excellent multidisciplinary team working within the service and with other agencies.

Care and treatment of children and support for their families was delivered in a compassionate, responsive and caring manner. Parents spoke highly of the approach and commitment of the staff who provided a service to their families.

Staff understood the individual needs of children, young people and their families and designed and delivered services to meet them.

There were clear lines of local management in place and structures for managing governance and measuring quality. However, some staff felt isolated from the main trust and highlighted a lack of engagement and visibility from senior managers.

Updated 17 December 2015

Overall rating for this core service Requires Improvement

Although we rated the service outstanding for providing caring services and good for providing effective services, overall, we rated the services as requiring improvement.

Somerset Partnership NHS Foundation Trust has 17 dental clinics across Somerset, Dorset and the Isle of Wight area. There are 13 clinic locations, excluding the locations where general anaesthetic services are provided. There are 10 clinics in Somerset, plus 2 Hospital locations. There are 3 clinics in Dorset, and one location for paediatric general anaesthetic services, as well as a Community Hospital location for adult general anaesthetic services.

During our inspection we visited seven locations which provided a special care dental service:

Bridgwater Dental Access Centre – special care dental treatment for all age groups.

Glastonbury Dental Access Centre - special care dental treatment for all age groups.

Taunton Dental Access Centre – special care dental treatment for all age groups.

Yeovil Dental Access Centre – special care dental treatment for all age groups.

The Browning Centre – dental treatment for adults with an impairment, disability or complex medical condition.

Canford Heath Dental Clinic – dental treatment children who are unable to tolerate treatment in the general dental practice setting.

The Dorset County Hospital - oral health care and dental treatment for adults with an impairment, disability and/or complex medical condition.

Overall we found dental services provided effective and caring treatment. We observed and heard practitioners were providing and excellent service in all locations with exceptionally caring compassionate and respectful staff.

We found the service was not providing safe care as identified risks were not always acted upon in a timely manner and equipment was not always serviced or appropriately managed for the safety of patients. The services were not responsive to the needs of patients referred to them in a number of areas, there were large numbers of patients waiting to be assessed and waiting lists were long.

The service was not well led as leadership, management and governance of the organisation did not assure the delivery of care in a supported learning and open environment across the service provision. There was limited devolved leadership to location managers and lead clinicians to empower them to make the necessary local judgements and actions for the safety and well-being of patients.

The two Dorset locations were well led locally. The issue was with the central leadership. Although this was beginning to be addressed by Clinical Support Managers who came across from the Somerset locations. Staff did report that although in its infancy it was a good innovation.

The Somerset locations were well led locally but were not always empowered to ensure all required actions for the efficient and effective running of the location. For example they told us they had reported issues relating to premises risks and maintenance and had been unable to obtain a response and action from the trust.

Dental services were effective and focussed on the needs of patients and their oral health care. We observed good examples of effective collaborative working practices and sufficient staff available to meet the needs of the patients who visited the clinics for care and treatment.

All the patients we spoke with, their relatives or carers, said they had positive experiences of their care. We saw good examples of care being provided with compassion; and effective interactions between staff and patients. We found staff to be hard working, caring and committed to the care and treatment they provided. Staff spoke with passion about their work and conveyed how dedicated they were in what they did.

At each of the locations we visited staff responded to patients needs. We found the organisation actively sought the views of patients, their families and carers. People from all communities, who fit the criteria, could access the service. Effective multidisciplinary team working ensured patients were provided with care that met their needs, at the right time and without delay.

The service required improvement to the leadership. Organisational, governance and risk management structures were not in place to enable and empower staff in the locations to ensure safe and responsive care. The senior management team were not always visible across the area of whole area of service delivery. Staff described a culture that encouraged openness locally however some locations visited told us they could not express this a Trust level and be heard. Staff in these locations reported low morale because they did not feel supported by senior managers.

Staff were not always aware of the vision and way forward for the organisation and some said they did not feel supported or able to raise concerns.

Updated 22 January 2019

• The service worked closely with the local NHS acute trusts and developed care pathways for discharge. This supported rehabilitation services and reduced length of stay for patients. Staff, teams and services within and across different organisations worked together to deliver effective care, treatment and discharge arrangements for patients. The trust set up a project board to manage and monitor delayed transfers of care in order to take a system wide approach.
• Patients’ care, treatment and support achieved good outcomes, promoted a good quality of life and was based on the best available evidence. Patients’ physical, mental health and social needs were holistically assessed and cared for. Staff gave patients enough food and drink to meet their needs and improve their health. Patients’ pain was assessed and managed including those with difficulties in communicating. Patients were empowered and supported to manage their own health, care and wellbeing and to maximise their independence.
• All the community hospitals looked visibly clean, corridors were not cluttered with equipment and fire doors were not blocked. Equipment and the premises were kept clean and staff used control measures to prevent the spread of infection. The facilities and premises were appropriate for the services that were delivered. Colour schemes were ‘dementia friendly’ and there was good access for people using wheelchairs
• Staff went above and beyond to provide exceptional care for patients. Patients were treated with respect, kindness, compassion and had their privacy protected by staff.
• Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff recognised incidents and reported them appropriately. All staff had a good understanding of the duty of candour and could describe when it would be used.
• The trust was working hard to ensure all hospitals were staffed safely and that good quality care could be delivered. Several different strategies were being implemented to overcome staffing issues.
• Staff felt supported, respected and valued by the trust. The culture of the hospitals and teamwork was strong and staff were supportive of each other. The trust had found ways to support staff with new roles and the development of existing staff.
• Strong leadership was demonstrated at the community hospitals. All members of the leadership team we spoke with showed skills, knowledge, passion and experience to lead the service in a collaborative working style.

However:

• Some medicines requiring disposal were not always stored securely. Some blank prescriptions were not monitored and we saw some patient group directions were out of date.
• Clinical and management supervision was not embedded in community hospitals to support staff

Updated 23 January 2023

Updated 22 January 2019

We rated child and adolescent mental health wards as good because:

• Staff and young people worked together to identify and manage risks and develop risk assessments. Staff had detailed knowledge of the risks and the care needs of the young people and where skilled and experienced in working with them. There were sufficient staff to carry out physical interventions safely. The team had a local risk register that had items so that risks could be identified, escalated and addressed.
• Environmental risks, including some fixed ligature points, had been assessed and were managed appropriately by staff. The environment was clean and tidy. Alarms were on hand to call for an assistance. Young people were searched appropriately on return from unescorted leave. Young people’s rooms were searched when warranted, for example after an incident of self-harm, by staff to maintain a safe environment. Staff were trained in safeguarding and knew how identify, manage and report safeguarding issues.
• Care plans were holistic and created with the young people on the ward. There was a variety of treatment and interventions on offer that were in line with national guidance and best practice. Consent and capacity was recorded appropriately in the young person’s notes. There was a skilled multidisciplinary team that met regularly for meetings to discuss young people’s care. Mental Health Act rights had been explained regularly to those young people detained under the Mental Health Act.
• Staff were caring and demonstrated respectful attitudes towards the young people and were knowledgeable around their care plans. Throughout the admission process, staff reassured and helped young people settle into the ward.
• Young people were involved in decisions about the service and there were meetings to collect feedback from the young people admitted to the ward. Advocacy services were readily available. Staff ensured young people had good access to education.
• Young people had their own bedroom with an ensuite bathroom. There was a full range of facilities available.
• Carers were included and consulted in the care provided. Young people and their families knew how to raise concerns or complaints.
• Managers understood and knew their ward and the challenges they faced. Staff were aware of the trust values and how they applied in the work of their team. Staff we spoke with felt respected, supported and valued by their team.
• Staff felt able to raise concerns and were supported in the process. Staff had implemented recommendations from events such as incidents, deaths and complaints.
• The trust provided specific Mental Health Act training however this was not mandatory for staff and managers found it difficult to release staff for training. Despite this, we found that knowledge of the Mental Health Act was good.

However:

• Staff felt that from the wider trust communication could be improved as they didn’t always know why changes were being made. There were no clear frameworks of what must be discussed at a ward, team or directorate level in team meetings.
• There was no dedicated specific dietetic support for the ward and staff stated that it was difficult to access from other areas of the trust. This had been raised with the managers and escalated to the trust.
• The service did not regularly collect feedback from families and carers.
• The ward applied some blanket restrictions, for example young people always had to request access to the outside areas and were observed by staff. Staff discussed blanket restrictions at team meetings and a positive and proactive best practice meeting.

Updated 23 January 2023

Updated 1 June 2017

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

During this most recent inspection, we found that the service had addressed the issues that had caused us to rate it as inadequate following the September 2015 inspection. The community mental health services for people with learning disabilities were now meeting Regulation 17 of the Health and Social Care Act (Regulated Activities) Regulations 2014.

• Staffing levels were good and there was managerial and team oversight of the safe management of caseloads.
• The staff team had worked hard to develop new systems to ensure that all service users had holistic and detailed care plans that addressed known risks and areas of treatment that service users required. They were available in a format that people who used the service could understand.
• Interactions between staff and service users and their carers were warm, good humoured, and professional. The staff team ensured service users were included in the development of new accessible templates and care plans.
• There were managerial systems in place to audit clinical notes to ensure risk assessments and care plans were updated and completed correctly, ensure staff received training and yearly appraisals.
• We rated well led as outstanding because of the dramatic improvements in the service since our September 2015 inspection. This was due to the leadership of the divisional manager who had just been appointed at the time of our last inspection and the service manager who had been appointed by the trust to complete the transformation. The team leaders had also embraced the need for change and worked to support their teams in the process. Staff morale was high and staff were keen to show us the improvements to the service. Staff were fully involved in the improvements and changes to the service, with groups of staff from each team reviewing how the service worked for patients and asking is the service safe, effective, caring, responsive and well led. The trust had supported this change with a no blame approach to the staff team following the previous rating of inadequate. The trust had requested support from another NHS organisation with a good learning disability service to help with the improvement plan and there was visible senior management support for the service development, including the chief executive attending meetings in the service and shadowing visits.

However:

• Staff did not have access to alarms in Yeovil.

• The service did not have sufficient systems in place to ensure that all clinicians completed their reviews of patients. This was addressed when we brought it to the services attention.

• Staff did not always update risk assessments after they had completed a piece of work with the patient which had resulted in the risk lowering.

Updated 22 January 2019

• Staff completed risk assessments for patients when they initially met them. Staff knew how to keep patients safe. Staff made appropriate safeguarding alerts and were appropriately trained to identify safeguarding concerns. Staff were trained in safeguarding and they accessed support of the trust’s safeguarding team. Staff completed mandatory and specialist training.
• Patients and carers gave good feedback about the service and said that staff were supportive, understanding, reliable, kind, caring and communicated well with them. Staff enabled patients to give feedback on the service and they followed a nationally recommended approach to working in partnership with carers to support patient care.
• Teams had effective working relationships with other teams within the organisation and with other agencies such as primary care and social services. They met with other agencies to look at patients’ holistic needs. Staff encouraged patients to develop links with other agencies that could help them and gave them support and advice about their conditions, medicines, treatments, services and about how to live a healthier life.
• The service was responsive to patients’ needs. All the teams were meeting the targets for referral to assessment which were six weeks for routine referrals and five working days for urgent referrals. Emergency referrals were seen the same day. Emergency referrals were seen the same day and all teams had a member of staff on duty each day to respond to calls from or about patients and carers.
• A full range of specialists provided care and treatment interventions suitable for the patient group that were in line with national best practice guidance.
• The trust communicated well with staff through the intranet, bulletins and newsletters. Staff met regularly to discuss the service and the patients they were treating. They discussed learning from complaints, incidents and from audits. They used these meetings to plan improvements to the service. Team managers held regular meetings with each other to improve the service and develop a consistent service across the county.
• The provider recognised staff success within the service with certificates of recognition and appreciation for making a positive difference in the workplace. The Burnham-on-sea manager and memory service had received these.
• We saw some positive, committed leadership in teams and some staff were complimentary about their managers and felt supported.

However:

• There were delays in getting approval to advertise vacant posts that meant posts could remain vacant for up to six months. This put additional pressure on staff who covered the work. Staff across the service said they were pressured and stressed by their workloads at times.
• Managers provided staff with line management supervision, but it was not always provided regularly. Some staff had access to additional clinical supervision and other staff did not.
• There were variations in the quality of care records. According to 43 care records we reviewed of patients across the whole service, a small number had not been given a copy of their care plan, some care plans lacked personalisation, and a holistic and recovery-oriented approach.
• The Yeovil team told us they felt unappreciated, stressed and morale was low. They complained of a lack of positive feedback. Some staff felt ‘done to’ rather than ‘done with’. Some staff said they felt disconnected from senior management. Staff did not know who the speak up guardian was for the trust or how to contact them. The trust had already recognised this and had put in place an action place to address this.

Updated 22 January 2019

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

• There were sufficient staff with the right training, knowledge and skills to provide safe care and treatment; staff received appropriate supervision. Staff completed thorough risk assessments and had a good awareness of safeguarding issues. There were robust incident reporting processes and managers ensured any lessons learned were cascaded to staff.
• Staff used best practice and national guidance to complete comprehensive assessments of patients, and communicated patient need well within the multidisciplinary team, the wider trust and with their external partners as appropriate.
• Patients told us that staff treated them with respect and that they were involved in their own care planning. They felt listened to and both patients and carers were provided with relevant information and support to manage their condition.
• The service had a positive patient-centred culture which was demonstrated consistently throughout the treatment period.
• At our last inspection in September 2015, admission into the health based places of safety out of hours sometimes resulted in a lengthy wait for assessment. By the time of this inspection, this had improved and people were being assessed in a timely manner. From 1st January 2018 to 10th October 2018, assessments were consistently completed within 24 hours regardless of the time of day that the person was admitted.
• At our last inspection in September 2015, staff at the places of safety were not always confident or clear on provision of support out of hours, or around the joint working arrangements under the Section 136 joint protocol. By the time of this inspection, this was no longer the case and staff were well informed of the procedures and protocols specific to the places of safety.

• The home treatment teams responded to patient need quickly and managed their caseloads effectively to ensure they could respond to concerns in a timely way. The teams were meeting their expected targets and had effective complaints procedures in place. None of the home treatment teams had waiting lists, and the risk of patients on the caseload was discussed informally, and formally at daily handovers.

• Governance arrangements were in place and robust. Leaders had clear oversight of their services. Managers and staff monitored the quality and effectiveness of the service through feedback and key performance indicators. Morale was high and staff were innovative.

However:

• The trust lone working policy was inconsistently applied across the home treatment teams, which meant staff could be at risk if colleagues did not know of their whereabouts. We raised this at the time of our inspection and the trust assured us they would take action.
• Medical staff did not always receive clinical supervision as per trust policy.

Updated 1 June 2017

We rated Somerset Partnership NHS Foundation Trust as good because:

• The trust had addressed the problems that had caused us to rate effective as requires improvement when we last inspected in September 2015. These included ensuring that patients were aware of their section 132 rights when detained under the Mental Health Act, that staff documented patients’ consent to medicines and that patients received feedback from second opinion appointed doctors.
• The wards were clean, and staff were managing risks within the ward environment. These included checking medical devices and ensuring that staff levels met the needs of patients.  Staff had risk assessed patients in their care and had systems in place to ensure that learning was shared from any incidents on the ward.
• We spoke with three patients and they provided positive feedback on the activities on the ward. Patients we spoke with said that staff treated them with respect and dignity and we saw that this was the case on our inspection visit. Staff encouraged patients to give feedback on the service and ensured that they had access to advocacy. Staff took care to involve patients’ family and carers as appropriate and according to the patient’s wishes.
• Staff had a focus on discharge. They planned for discharge for all of their patients and they tracked patients’ progress towards discharge. Staff liaised with other services to help ensure rapid but appropriate discharge when patients needed either more or less intensive care than they could receive on the ward. The facilities of the ward allowed patients a range of rooms to use for activities and therapies. The ward also had access for people requiring mobility aids. Staff ensured that patents could continue to practice their different cultural and religious beliefs.
• The ward had strong local leadership, and this had helped staff to develop a good working team. NHS England commissioned the ward and required them to provide a range of performance data. This meant that in the majority of cases, governance systems were embedded and worked well. The ward was also part of a peer led quality network – the Royal College of Psychiatrists’ quality network for forensic mental health services.

However:

• The trust had not fully rolled out its training programme on the Mental Health and Mental Capacity Acts.
• While seclusion was rare on the ward, it was only used six times in the year before this inspection, staff did not always documented the checks they were supposed to make in line with the trust’s policy. Seclusion is where a patient is contained and supervised in a room that may be locked because they are highly agitated and their behaviour is likely to present a risk of harm to others.

Updated 22 January 2019

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

• The ward was clean, spacious, and well maintained. It was a positive environment which focused clearly on rehabilitation needs and enabling patients to move out of hospital and live in the community. The atmosphere was warm and friendly and the environment comfortable and welcoming.
• Staff completed thorough environmental risk assessments and mitigated identified risks on an ongoing basis. Staff knew, assessed, managed and communicated individual risks well.
• The staff team were knowledgeable, skilled and cohesive. Staff demonstrated effective application of relevant legislation and good practice; in line with national guidance. Staff provided a range of care and treatment within the therapeutic rehabilitation service. Patients had access to a range of multidisciplinary staff to meet their mental and physical health needs. Patients were supported to reintegrate into their community and independent living.
• Documentation was complete and assessments were comprehensive, holistic and thorough.
• Care plans were kept up to date, personalised with clear outcomes and goals identified which included plans for discharge, and clearly evidenced the involvement of patients throughout.
• The ward had a progressive ethos and the team were constantly looking at innovative ways to engage and use the patient voice and experience to develop staff competence and improve rehabilitative outcomes. For example, a patient was supported to deliver a training session to staff following some work with the ward psychologist on how best to meet their needs.
• Staff encouraged and supported patients and carers to be involved in their care as much as practically able and ensured clear discharge planning took place with the patients.
• Staff were respectful, supportive and responsive to patients’ needs.
• The service was well led, leaders and managers had the skills and knowledge to provide good quality leadership, were visible and accessible. The trust senior directors and board members visited the service regularly.

However:

• Not all staff had completed Mental Capacity Act and health and safety awareness training.

Updated 1 June 2017

We rated wards for older people with mental health problems as good overall because:

• During this inspection, we found that the services had addressed the issues that had caused us to rate safe, effective and well led as requires improvement following the September 2015 inspection. The wards for older people with mental health problems were now meeting Regulations 12 and 11 of the Health and Social Care Act (regulated Activities) Regulations 2014.

• Staff assessed and addressed risks associated with the physical environment and implemented appropriate measures to mitigate the risks to people using the services. Staff received training and support to manage patients with challenging behaviours and the teams managed risk well. Staff completed thorough risk screens and communicated risk throughout different forums. Safeguarding was a high priority and staff completed mandatory training. The environments were very clean and hygienic and managers had closed some beds in order to support safety due to staffing shortages.

• Staff demonstrated they provided care and treatment with the consent of each patient, demonstrated good understanding and application of the Mental Capacity Act (MCA), and associated Best Interest decisions. Staff acted in accordance with the MCA in instances where there was a formal instruction of do not attempt cardiopulmonary resuscitation in place.

• Patient care records were complete and up to date, and each patient had a care plan outlining risks and day to day needs. All care records contained complete information, including medication. All physical health monitoring was taking place. There was good multidisciplinary and multi-agency communication.

• There were good examples and evidence of learning from incidents and changes made following incidents. Staff felt supported around incidents.

• Staff treated patients with kindness and respect. We observed excellent examples of good quality care and positive and supportive staff attitudes. Without exception, the staff were professional, courteous and committed to providing the best level of care possible. The trust had nominated and given staff awards around dignity and care of patients.

• The wards had good local bed management systems and were creative in managing the pressures around demand and discharge problems out of their control.

• Local governance systems were good and managers ensured they supported staff. Staff had good morale and demonstrated openness and transparency. There was strong local leadership. The ward managers were visible and staff told us they were approachable and supportive.

However:

• The majority of care plans or records were person centred but did not always demonstrate patient involvement. We did not find clear evidence in the care records to show that staff had discussed or offered patients their care plan, even if they had refused it.

• Staff did not feel fully confident or skilled in managing specific mental health problems such as schizophrenia, particularly the nursing assistants on the wards. The trust did not provide specific training to develop these skills.

• Managers did not ensure staff received regular supervision as per their own trust supervision policy.

Updated 23 January 2023

Updated 1 June 2017

We rated Somerset Partnership Foundation Trust as good because

• During this most recent inspection, we found that the service had addressed the issues that had caused us to rate safe responsive and well led as requires improvement following the 2015 inspection. We found at the previous inspection in 2015 that there had been issues with the management of patients on the waiting list for allocation of a care coordinator. This had resulted in a breach of a regulation resulting in a requirement notice. By the time we revisited in March 2017, four of the five sites had made improvements to how staff managed waiting lists. At the Mendip site there had been continuing issues that the trust had identified and responded to with a temporary change of management. We found that there was a positive air within the service despite there being an extended period of change over the past year with more change proposed through the review of the community mental health service.

• The service had some excellent areas of practice particularly at the wellbeing clinic at the Taunton site. The management of the clozapine blood clinic at the Taunton site used pharmacy technicians, which meant that staff could administer medication without patients having to wait for an extended amount of time.

• Staff were risk aware and had worked with patients to assess risk, create crisis plans and to plan care that was meaningful to them. There were practices in place to protect patients from abuse with the staff being knowledgeable of the safeguarding policy and process within the trust. There was a safeguarding lead in place to provide staff with support when they needed to escalate a safeguarding incident. Staff had use of an electronic incident reporting system to escalate incidents that occurred within the service. We found that there was a positive approach to incident reporting and that when there were serious incidents the trusts’ investigations were effective and lessons learnt were cascaded amongst the staff.

• Staff comprehensively assessed patients on first contact. We observed assessments and found that staff were caring and treated patients with respect within the assessments. Assessments covered a number of areas to do with the patient’s life and were holistic in their nature. Staff followed national guidance to inform their practice. Staff provided both therapies and medicines according to National Institute for Health and Care Excellence (NICE) guidance. Staff recorded outcomes and used nationally recognised rating scales in order gauge the severity of a particular condition.

• Staff used supervision to review their caseloads and get support from their line managers and we found that there was good interagency working within the teams. Staff supported each other and used the different skills within the team to inform their practice, for example a joint assessment of a patient with a suspected eating disorder.

• We reviewed Mental Health Act paperwork and found that staff completed it in line with guidance. Staff had completed capacity assessments when appropriate.

• We observed episodes of care that showed how staff worked with patients to create a plan of care. Staff worked with patients to look at options around areas such as work and housing. They treated patients with dignity and respect in their interactions.

• Care coordinators within the service assessed patients within the set referral to assessment time of six weeks. There were arrangements in place for when staff needed to see a patient more urgently. Managers determined the size of the caseload that staff carried and ensured that these were consistent across the service according to the hours that each staff member worked. Staff demonstrated how they followed up patients that did not attend their appointments. We reviewed the environment at all of the community sites and we found that there was good access for patients with a physical disability. There were also examples of how staff worked with patients that did not speak English. There was a clear complaints process in place and we found that staff responded to complaints within the team as well as directing patients to the trusts patient advice and liaison service (PALS).

• Staff were aware of the values set by the trust. We heard of positive change made to the trust from the appointment of a new chief executive, he was responsive to staff emails. There was generally good local leadership and local management were able to show how they had responded to the requirement notice from the previous inspection. Managers within the service were visible and supportive to staff. Managers demonstrated how they used the risk register to escalate issues, for example, the clinic room at the Taunton site was not fit for purpose so was placed on the risk register to initiate a change. Staff were aware of how to raise concerns within the trust and felt confident in using the whistleblowing policy as well as raising concerns locally.

However:

• The environment at the Yeovil site appeared tired and in need of updating. There was no local log of complaints made to the community mental health teams. While there was a record of formal complaints, there was no oversight and recording of informal complaints, this meant that managers did not have a record of potential trends. Staff told us that the extended period of change that they had experienced through the changes to the social worker provision had affected the morale of the teams.