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Provider: North Staffordshire Combined Healthcare NHS Trust Outstanding

We are carrying out checks on locations registered by this provider. We will publish the reports when our checks are complete.

Reports


Inspection carried out on 04 Dec 2018 to 23 Jan 2019

During a routine inspection

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

  • We rated safe, effective, and well led as good, caring and responsive as outstanding. Following this inspection, one of the trust’s 11 services are rated as requires improvement, seven are rated good and three as outstanding. In rating the trust, we took into account the previous ratings of the eight services not inspected this time.
  • The trust had met the requirement notices we set out in our previous report. Medicines safety had improved on the wards for older adults and the community teams. Staff in the community teams now inspected emergency equipment as a matter of routine.
  • There was good leadership across the trust from the board to front line managers. Managers had the right skills to undertake their roles. The board had good understanding of performance.
  • The trust ensured that risk assessments were completed and updated regularly. Staff updated risk assessments for each patient to understand how to best support them. Staff had good access to patient records and stored them safely. Staff knew how to keep patients safe and reported incidents, including abuse, when necessary. Staff learnt lessons from incidents.
  • A range of care and treatment interventions was delivered in line with guidance from the National Institute for Health and Care Excellence (NICE).
  • The majority of staff had good knowledge of the Mental Health Act, the Mental Capacity Act and the Deprivation of Liberty Safeguards. Staff were up to date with training in the Mental Health Act and Mental Capacity Act.
  • Staff treated patients with compassion and kindness. They respected patients’ privacy and dignity, and supported their individual needs.
  • Staff involved patients and those close to them in decisions about their care, treatment and changes to the service. Throughout their recent management of change project, the trust had listened and acted on the feedback of patients, their families and carers.

However:

  • The trust had not met its responsibility to make all required notifications to the CQC. There had been no notices made of the outcomes of applications to authorise Deprivation of Liberty Safeguards. We had reminded the trust of this obligation in our last report.
  • The stability of the senior leadership of the trust was at risk with changes in the executive team. The new chief executive, chairperson and remaining board members recognised an opportunity to reflect on their structures, processes and external relationships.
  • Enhanced reporting on clinical activity in community teams had recently been introduced, which provided assurance to the Board and service managers, but required development to fully establish its reliability and usability

  • The trust’s pharmacy team was still developing its strategic plan. The team had made some progress in the last year through development of the team’s capacity and skill base.
  • Some community service’s environmental risk management plans lacked detailed mitigation of identified risks.
  • There were some omissions in community and crisis services patient care plans related to crisis plans, physical care plans.


CQC inspections of services

Service reports published 28 March 2019
Inspection carried out on 04 Dec 2018 to 23 Jan 2019 During an inspection of Reference: not found Download report PDF | 394.79 KB (opens in a new tab)Download report PDF | 1.3 MB (opens in a new tab)
Inspection carried out on 04 Dec 2018 to 23 Jan 2019 During an inspection of Community-based mental health services for adults of working age Download report PDF | 394.79 KB (opens in a new tab)Download report PDF | 1.3 MB (opens in a new tab)
Inspection carried out on 04 Dec 2018 to 23 Jan 2019 During an inspection of Mental health crisis services and health-based places of safety Download report PDF | 394.79 KB (opens in a new tab)Download report PDF | 1.3 MB (opens in a new tab)
Inspection carried out on 04 Dec 2018 to 23 Jan 2019 During an inspection of Wards for older people with mental health problems Download report PDF | 394.79 KB (opens in a new tab)Download report PDF | 1.3 MB (opens in a new tab)
Inspection carried out on 04 Dec 2018 to 23 Jan 2019 During an inspection of Reference: not found Download report PDF | 394.79 KB (opens in a new tab)Download report PDF | 1.3 MB (opens in a new tab)
See more service reports published 28 March 2019
Service reports published 16 April 2018
Inspection carried out on 14 November 2017 During an inspection of Wards for older people with mental health problems Download report PDF | 237.29 KB (opens in a new tab)
Service reports published 15 February 2018
Inspection carried out on 2 Oct to 2 Nov 2017 During an inspection of Acute wards for adults of working age and psychiatric intensive care units Download report PDF | 436.45 KB (opens in a new tab)Download report PDF | 1.49 MB (opens in a new tab)
Inspection carried out on 2 Oct to 2 Nov 2017 During an inspection of Wards for people with a learning disability or autism Download report PDF | 436.45 KB (opens in a new tab)Download report PDF | 1.49 MB (opens in a new tab)
Inspection carried out on 2 Oct to 2 Nov 2017 During an inspection of Specialist community mental health services for children and young people Download report PDF | 436.45 KB (opens in a new tab)Download report PDF | 1.49 MB (opens in a new tab)
Inspection carried out on 2 Oct to 2 Nov 2017 During an inspection of Wards for older people with mental health problems Download report PDF | 436.45 KB (opens in a new tab)Download report PDF | 1.49 MB (opens in a new tab)
Inspection carried out on 2 Oct to 2 Nov 2017 During an inspection of Long stay or rehabilitation mental health wards for working age adults Download report PDF | 436.45 KB (opens in a new tab)Download report PDF | 1.49 MB (opens in a new tab)
See more service reports published 15 February 2018
Service reports published 21 February 2017
Inspection carried out on 12 - 16 September 2016 During an inspection of Mental health crisis services and health-based places of safety Download report PDF | 308.25 KB (opens in a new tab)
Inspection carried out on 12 – 16 September2016 During an inspection of Community-based mental health services for older people Download report PDF | 337.25 KB (opens in a new tab)
Inspection carried out on 13 - 15 September 2016 During an inspection of Long stay or rehabilitation mental health wards for working age adults Download report PDF | 320.62 KB (opens in a new tab)
Inspection carried out on 12-15 September 2016 During an inspection of Substance misuse services Download report PDF | 355.18 KB (opens in a new tab)
Inspection carried out on 12 - 16 September 2016 During an inspection of Acute wards for adults of working age and psychiatric intensive care units Download report PDF | 373.3 KB (opens in a new tab)
Inspection carried out on 13th September to 16th September 2016 During an inspection of Specialist community mental health services for children and young people Download report PDF | 329.21 KB (opens in a new tab)
Inspection carried out on 12th - 16th September 2016 During an inspection of Community-based mental health services for adults of working age Download report PDF | 398.79 KB (opens in a new tab)
Inspection carried out on 12-13 September 2016 During an inspection of Wards for older people with mental health problems Download report PDF | 400.38 KB (opens in a new tab)
Inspection carried out on 12-15 September 2016 During an inspection of Child and adolescent mental health wards Download report PDF | 359.18 KB (opens in a new tab)
Inspection carried out on 13th - 16th September 2016 During an inspection of Community mental health services with learning disabilities or autism Download report PDF | 312.99 KB (opens in a new tab)
Inspection carried out on 12- 13 September 2016 During an inspection of Wards for people with a learning disability or autism Download report PDF | 310.3 KB (opens in a new tab)
See more service reports published 21 February 2017
Service reports published 1 September 2016
Inspection carried out on 27 April 2016 During an inspection of Specialist community mental health services for children and young people Download report PDF | 283.42 KB (opens in a new tab)
Service reports published 22 March 2016
Inspection carried out on 7th -9th September 2015 During an inspection of Wards for people with a learning disability or autism Download report PDF | 318.85 KB (opens in a new tab)
Inspection carried out on 08/09/2015 During an inspection of Long stay or rehabilitation mental health wards for working age adults Download report PDF | 370.76 KB (opens in a new tab)
Inspection carried out on To Be Confirmed During an inspection of Substance misuse services Download report PDF | 281.03 KB (opens in a new tab)
Inspection carried out on 8-11 September 2015 During an inspection of Acute wards for adults of working age and psychiatric intensive care units Download report PDF | 354.46 KB (opens in a new tab)
Inspection carried out on 7 - 11 September 2015 During an inspection of Child and adolescent mental health wards Download report PDF | 345.37 KB (opens in a new tab)
Inspection carried out on 7 – 11 September 2015 During an inspection of Community-based mental health services for older people Download report PDF | 319.34 KB (opens in a new tab)
Inspection carried out on 8th – 9th September 2015 During an inspection of Wards for older people with mental health problems Download report PDF | 340.44 KB (opens in a new tab)
Inspection carried out on 8-11 September 2015 During an inspection of Community mental health services with learning disabilities or autism Download report PDF | 310.11 KB (opens in a new tab)
Inspection carried out on 7-11/09/2015 During an inspection of Community-based mental health services for adults of working age Download report PDF | 351.85 KB (opens in a new tab)
Inspection carried out on 7-10 September 2015 During an inspection of Specialist community mental health services for children and young people Download report PDF | 328.13 KB (opens in a new tab)
Inspection carried out on 7-11 September 2015 During an inspection of Mental health crisis services and health-based places of safety Download report PDF | 385.38 KB (opens in a new tab)
See more service reports published 22 March 2016
Inspection carried out on 2 Oct to 2 Nov 2017

During a routine inspection

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

We rated safe as requires improvement, effective and well led as good, caring and responsive as good. Following this inspection, nine of the trust’s 11 services are rated as good and two as outstanding. In rating the trust, we took into account the previous ratings of the five services not inspected this time.

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

  • The organisation had developed from a control and command to a clinically led culture with robust engagement and involvement of service users, carers and staff. Senior managers and service level managers were visible and accessible to staff. This demonstrated a better connect between clinical services and senior management.
  • The overall culture of the trust was very patient centred. Staff treated patients with dignity, respect and compassion. The majority of staff experienced high morale and motivation for their work and felt valued and recognised through recognition and award schemes developed within the organisation.
  • Patient and carer engagement had been sustained at a high level within this organisation.
  • Teams in the majority of services worked collaboratively and effectively to best meet the needs of individual patients they cared for. Strong team cohesion on the adult acute wards had contributed to a reduction in restraint and incidents. There was strong communication through a variety of methods and meetings structures across the organisation.
  • The trust had a good physical health strategy that focussed on the integration of primary health care with mental health. A new physical health team had also recently been created to support staff.
  • The trust and its staff were committed to improving services by learning from when things go well and when they go wrong. We saw evidence of changes following patient and staff feedback in most services.
  • The trust’s investment in focus on improving care plans and risk assessment across its services was demonstrable with only minimal inconsistencies in a few services.

However:

  • The trust recognised they were on a journey of embedding a new electronic recording system across the services within the organisation. Managers had employed several methods to engage and support staff in this endeavour and recognised there was further work to be undertaken in the full implementation and use of new systems.
  • The medicine optimisation team was stretched to capacity only achieving 80% of medicines reconciliation within 24 hours. The Pharmacy technicians lacked professional support through structured supervision.
  • The depth, rigour, testing of changes in practice following serious incidents could be further strengthened.
  • The trust had a good workforce plan and had implementation of new recruitment processes. However, these had yet to come together and positively impact on the timeliness of recruitment to vacancies succession planning which were highlighted as a concern by staff across most services.
  • The trust had done a lot of work around further developing their processes and structures that supported equality and diversity in their workforce. However, this was not fully represented across all of the services inspected.

Inspection carried out on 12-16 September 2016

During a routine inspection

Following the inspection in September 2016, we have changed the overall rating for North Staffordshire Combined Healthcare NHS Trust from requires improvement to good because:

  • The trust had made considerable improvements to the quality of care and to the governance mechanisms that underpin and provide assurance since our last inspection in September 2015. The trust board had become more settled with an increased number of directors in substantive rather than interim posts and this had helped to ensure that governance systems were embedded.
  • Since our inspection in September 2015, the trust had made significant improvements to the quality of care plans and risk assessments. Documentation consistently showed a collaborative approach to care that involved staff, patients, carers and families.
  • The staff throughout the trust displayed a caring attitude towards people who used the services. We saw several examples of staff showing kindness, empathy and putting peoples’ needs first. Feedback from patients, carers and families was also very positive and staff ensured that delivery of care was carried out in a co-productive manner.
  • The majority of the core services were responsive to the needs of the people who used them. We saw some excellent examples of where staff had addressed issues with high ‘did not attend’ appointment rates in community teams by adapting the service to meet the needs of the patients and carrying out the appointments at a location that suited them.
  • In most of the services that we visited, staff reported good morale and that they were supported by managers to carry out their roles effectively. The leadership across the trust had improved greatly since our last inspection and there was a sense of cohesion and determination among managers to continue in this vein.

However:

  • Although some improvements had been made to waiting lists and the monitoring of them in the specialist community mental health teams for children and adolescents, we found that a great deal more work was required to continue to improve and to assure the safety of those young people who had been assessed and were awaiting treatment.
  • In some teams, the storage of medicines was not always safe and we found that regular checks were not always being carried out to monitor rooms or fridges where medicines were kept.
  • In some services, physical health checks were not consistently being carried out following the administration of rapid tranquilisation.

Inspection carried out on To Be Confirmed

During a routine inspection

When aggregating ratings, our inspection teams follow a set of principles to ensure consistent decisions. The principles will normally apply but will be balanced by inspection teams using their discretion and professional judgement in the light of all of the available evidence.

We found that the North Staffordshire Combined Healthcare NHS Trust was performing at a level which led to a judgement of Requires Improvement.

We found inconsistencies in the leadership at board and executive team level. The Chief Executive had been in post for 18 months; we were impressed by her leadership skills. A strategy to improve safety, quality of care and patient experience has been developed, however, this process is in it’s infancy and as such not fully embedded trust wide. Key positions in the leadership team remain interim and we were concerned by the turnover in relation to the Director of Nursing role. However,

the Director of Nursing and the Director of Strategy and Development had been appointed but not yet commenced in post

Governance & data systems within the Trust were not robust and did not ensure that systems to enable the effective monitoring of safety, quality & risk are in place. However, we saw evidence that the Trust is developing systems for learning from incidents and complaints.

The provider failed to ensure that all people receiving a service were protected from potential harm due to ligature risks and poor quality of risk assessments. We have issued an Enforcement Action in relation to specialist community mental health services for children and adolescents which gives a strict timescale for them to improve.

The provider scored below the national average with regards to staff recommending the Trust as a place to work. Some of the staff that we spoke with felt disengaged from improvements that the leadership team are trying to embed. However, we saw evidence that the Trust is attempting to engage with staff and service users be developing initiatives such as ‘listening into action’ and the newly formed service user and carer council.

The Trust can be proud of the caring culture within the staff group. We saw consistent evidence of people who use Trust services being treated with dignity, kindness and respect.

We will be working with them to agree an action plan to assist them in improving the standards of care and treatment.

Intelligent Monitoring

We use our system of intelligent monitoring of indicators to direct our resources to where they are most needed. Our analysts have developed this monitoring to give our inspectors a clear picture of the areas of care that need to be followed up.

Together with local information from partners and the public, this monitoring helps us to decide when, where and what to inspect.


Joint inspection reports with Ofsted

We carry out joint inspections with Ofsted. As part of each inspection, we look at the way health services provide care and treatment to people.


Mental Health Act Commissioner reports

Each year, we visit all NHS trusts and independent providers who care for people whose rights are restricted under the Mental Health Act to monitor the care they provide and check that patients' rights are met. Immediate concerns raised by patients on those visits are discussed, if appropriate, with hospital staff.

Our Mental Health Act Commissioners may carry out a number of visits to each provider over a 12-month period, during which they talk to detained patients, staff and managers about how services are provided. In the past, we summarised themes from the visits and published an annual statement followed by the provider's response where applicable. We are looking at different ways to indicate the outcomes of our monitoring in the future.