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Provider: Tavistock and Portman NHS Foundation Trust Good

Reports


Inspection carried out on 13 August to 19 September 2018

During a routine inspection

However:

  • The monitoring of the quality and performance of the service lines was not sufficiently robust. At the time of the inspection, this took place through line management and an annual service line presentation to the board. Other governance systems looked across the service lines which could potentially lead to issues being missed or not given the focused attention they required.
  • The trust was working to implement a range of measures to improve career progression and address discrimination for black and minority ethnic (BME) staff. Some BME staff felt that these measures had not yet positively affected their experience of working for the trust. The trust leadership team recognised that this will take more time to fully embed.
  • The trust had experienced significant delays over the previous six months in responding to complaints relating to the gender identity clinic and had mostly missed the target for sending a response. Plans were in place to address this back-log. However, the complaint responses were of a high quality and showed empathy and a willingness to apologise where needed.
  • The trust was working to improve health and safety, including fire safety, across the trust, but this work needed to be completed and ongoing safety closely monitored to provide assurance.
  • People in GIC had long waits to access the service. They experienced a 13-month wait time for appointments and the service sometimes had to cancel and reschedule people’s appointment. The trust had tried to work with commissioners to increase funding but people still experienced long waits.


CQC inspections of services

Service reports published 16 November 2018
Inspection carried out on 13 August to 19 September 2018 During an inspection of Specialist community mental health services for children and young people Download report PDF (opens in a new tab)Download report PDF (opens in a new tab)
Inspection carried out on 13 August to 19 September 2018 During an inspection of Gender identity services Download report PDF (opens in a new tab)Download report PDF (opens in a new tab)
Service reports published 27 May 2016
Inspection carried out on 25 - 29 January 2016 During an inspection of Specialist community mental health services for children and young people Download report PDF (opens in a new tab)
Inspection carried out on 24 - 25 November 2016

During an inspection looking at part of the service

We have given an overall rating to Tavistock and Portman NHS Foundation Trust of good. We have rated the three services that we inspected as good.

  • At the last inspection in January 2016, we rated the specialist community mental health services for children and young people and other specialist services (gender identity development service) and as good in all areas.

  • At the last inspection in January 2016 we rated specialist psychological therapy services as good in four of the five domains including caring, effective, responsive and well-led. We rated safe as requires improvement. During this inspection we found that the trust had addressed the three issues leading to this rating and therefore changed the rating of safe to good. The issues from the January 2016 inspection were the use of crisis plans, risk assessments and management plans and having a separate waiting area for people under 18 at the Portman Clinic.

Inspection carried out on 25 - 29 January 2016

During a routine inspection

We have given an overall rating to Tavistock and Portman NHS Foundation Trust of good.

We have rated the three services that we inspected as good.

The trust has much to be proud of and also some areas that need to improve. The trust was well-led by the senior leadership team and board. There were many committed and enthusiastic senior staff throughout the organisation working hard to improve the delivery of psychological therapies, provide innovative services and national specialist services to children, young people and adults in out-patient and community settings.

The main areas which were positive were as follows:

  • We spoke with very caring staff in all of the services and teams we visited. They were clearly sighted on and understood the needs of patients they worked with. We received a lot of very positive feedback from patients and parents about staff.
  • There were several excellent examples of staff working in partnership with other organisations such as local schools, GPs and health visitors.
  • Staff were receiving very regular supervision, which they felt was of high quality. Staff were up to date with mandatory training and described significant opportunities for further professional development. All staff received an annual performance appraisal.
  • The staff provided patients with good quality psychological therapies. The psychological therapies provided were evidence-based. Some teams were undertaking innovative projects to enhance patient care and treatment or were involved in research.
  • Most staff had a good understanding of safeguarding policies and procedures in respect of both children and vulnerable adults.
  • The trust had recognised particular areas of local need and developed services to help meet those needs. For example, the excellent work with refugee communities.
  • Staff and managers had worked to address equality and diversity issues in the trust work force as well as improve access to psychological therapies for under-represented groups.
  • The trust had developed a number of creative and innovative initiatives aimed at involving patients in services and service development.
  • There were very high levels of job satisfaction amongst staff in all teams we visited and in the trust as a whole.

There were some areas which needed improvement. The main areas for improvement were as follows:

  • The documentation in relation to the risk assessment and risk management of patients was sometimes poor, particularly in the Portman clinic. Assessments did not always reflect actual risks. The local network involved in managing risks affecting patients was not always identified. Patients did not always have clear crisis plans in place that staff could find quickly in an emergency. Risk registers did not extend to team level which meant there was a risk that not all risks were being captured and reported at board level. In the Portman clinic adults and children and young people shared a waiting room. Despite mitigating action taken by the trust, this was not appropriate and potentially unsafe, especially given the risk histories and previous experiences of patients attending the clinic.
  • Services were struggling to implement the new electronic patient records system. Some services were keeping both paper and electronic records for the same patient, some paper records were poorly scanned making them difficult to read, and one service had not yet implemented the electronic patient record system. There were risks to patient care from running paper and electronic records systems side by side. The quality of data extracted from the system was unreliable.
  • The physical health needs of patients were not made a high priority. We noted the trust had recruited a physical health nurse one day a week, and was recruiting another, to improve the support offered to patients around smoking and alcohol use in particular. However, it was not clear that staff always considered the wider physical health needs of patients.
  • The trust had not carried out infection prevention and control risk assessments in all premises where patients were seen. This meant the trust could not be confident that all infection risks were being managed appropriately.
  • The trust had recently contracted a new independent advocacy provider. However, staff and patients were generally unaware of the service and we saw no advertising of the service in the areas we visited.
  • There was much creative and innovative work taking place in the trust. However, there was a lack of agreed strategy or frameworks in place to support continuous improvement and ensure sustainability.

We will be working with the trust 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.