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Provider: Oxford Health NHS Foundation Trust Good

Reports


Inspection carried out on 30th July 2019 to 25th September 2019

During a routine inspection

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

  • Since the last inspection in 2018 the trust has continued to make improvements despite facing some challenging funding issues. An independent report on the level of funding for mental health services in Oxfordshire (commissioned by Oxfordshire CCG, NHSE/I and OHFT) determined that there was a significant funding shortfall in mental health services. A further review carried out by Oxfordshire CCG highlighted a £12m shortfall in mental health funding but also a £10m shortfall in funding for community services. The shortage of funding has required an additional level of dedication and capability from the trust leaders and all the staff to maintain the capacity and quality of the services whilst managing scarce resources.
  • During this inspection we inspected six core services and carried out a well led review.
  • In rating the trust, we have taken into account the previous ratings of the ten mental health and community health core services not inspected this time. Following this inspection 14 core services were rated as good overall, one was rated requires improvement and one was rated outstanding.
  • We found that the trust was led by a highly skilled and experienced senior team, including the chair and non executive directors. There was a strong patient focussed, learning culture within the trust and staff showed caring, compassionate attitudes, were passionate and proud to work for the trust and were involved in the development and improvements within the trust.
  • The trust had made the majority of the improvements we said that it should make following our last inspection.
  • Across the trust the majority of the environments were safe, clean, well equipped, well maintained and fit for purpose.
  • In community services waiting lists were managed well, the number of patients on the caseload was not too high to prevent staff from giving each patient the time they needed and anyone needing to be seen urgently was seen in a timely manner.
  • In the wards for people with a learning disability staff had received training in positive behaviour support, patients had individualised behaviour support plans and staff were supporting patients who had challenging behaviours appropriately.
  • Generally, staff completed comprehensive risk assessments and managed risks well. Physical and mental health needs were assessed and monitored, and care plans were holistic and recovery orientated. Staff followed good practice with respect to safeguarding.
  • Patient safety incidents were managed well. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons with their teams and the wider organisation.
  • Staff provided a range of care and treatment interventions suitable for the patient groups and these were consistent with national guidance on best practice.
  • Staff across all the services we inspected were kind, compassionate, respectful and supportive respected the privacy and dignity of patients. Feedback from people using services and their relatives and carers was highly positive. People who used services were appropriately involved in making decisions about their care. Staff ensured that the emotional and spiritual needs of people who used services were addressed, along with their mental and physical healthcare needs.
  • The majority of services had access to the full range of specialists required to meet the needs of patients under their care. There was enough staff with a range of skills needed to provide high quality care. Staff from different disciplines worked together as a team to benefit patients. They supported each other to make sure patients had no gaps in their care. The teams had effective working relationships with other relevant teams within the organisation and with relevant services outside the organisation.
  • Staff planned and managed discharge well. Inpatient services, including wards for people with a learning disability and forensic secure wards, liaised well with services that would provide aftercare and were assertive in managing the discharge care pathway. As a result, people who used services did not have excessive lengths of stay and discharge was rarely delayed for other than a clinical reason.
  • The trust had strong governance systems supported by good quality performance information. This meant that at all levels of the organisation staff and members of the board had access to useful information that enabled them to gain assurance and make improvements where needed. This enabled the trust to achieve a balance between assurance and improvement work.
  • The trust had positive and collaborative relationships with external partners and was actively engaged with the local health economy in shaping services to meet the needs of the local population.
  • The trust continued to build on their innovation as a Global Digital Exemplar, sharing learning and supporting other trusts to make improvements in technology. There was good practice and innovation around IT that was patient focussed such as access to records and ‘I want great care’ and the Blue Ice app.
  • The trust had a strong focus on research and had strategic research links both to the University of Oxford and Oxford Brookes University. The trust ran one of only two mental health biomedical research centres in England.

However:

  • The seclusion rooms at both Evenlode ward (wards for people with learning disability and autism) and Watling ward (forensic inpatients) did not always offer privacy for patients. Staff on Evenlode were not secluding patients for the shortest possible amount of time. Records showed that patients who were settled were not removed from seclusion promptly so not protecting their human rights. Documentation was not always completed at the correct time.
  • Patients on Evenlode did not have access to a speech and language therapist; there had been no provision for 18 months.
  • In forensic services the quality of physical healthcare provided to patients was inconsistent between wards and the quality of pre-prepared meals on wards at the Oxford clinic was poor.
  • In forensic services there was a lack of parity of access to entertainment between wards. Patients on male wards had access to satellite television and a range of activities, whereas patients on the two female wards had been made to choose between having satellite TV and some activities that incurred a cost (for example, baking).
  • Ligature risk assessments were carried out but not always acted upon in Marlborough House inpatient ward.
  • In specialist community mental health services for children and young people the increase in demand and capacity issues had created increased wait times for non-urgent referrals.
  • Some staff said they found it hard to access supervision.
  • The was a lack of robust board level oversight of the Mental Health Act.


CQC inspections of services

Service reports published 13 December 2019
Inspection carried out on 30th July 2019 to 25th September 2019 During an inspection of Wards for people with a learning disability or autism Download report PDF (opens in a new tab)Download report PDF (opens in a new tab)
Inspection carried out on 30th July 2019 to 25th September 2019 During an inspection of Forensic inpatient or secure wards Download report PDF (opens in a new tab)Download report PDF (opens in a new tab)
Inspection carried out on 30th July 2019 to 25th September 2019 During an inspection of Child and adolescent mental health wards Download report PDF (opens in a new tab)Download report PDF (opens in a new tab)
Inspection carried out on 30th July 2019 to 25th September 2019 During an inspection of Community urgent care services Download report PDF (opens in a new tab)Download report PDF (opens in a new tab)
Inspection carried out on 30th July 2019 to 25th September 2019 During an inspection of Community-based mental health services for older people Download report PDF (opens in a new tab)Download report PDF (opens in a new tab)
Inspection carried out on 30th July 2019 to 25th September 2019 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)
See more service reports published 13 December 2019
Service reports published 30 August 2018
Inspection carried out on 5 March 2018 During an inspection of Community-based mental health services for adults of working age Download report PDF (opens in a new tab)Download report PDF (opens in a new tab)
Inspection carried out on 5 March 2018 During an inspection of Community health inpatient services Download report PDF (opens in a new tab)Download report PDF (opens in a new tab)
Inspection carried out on 5 March 2018 During an inspection of Community mental health services with learning disabilities or autism Download report PDF (opens in a new tab)Download report PDF (opens in a new tab)
Inspection carried out on 5 March 2018 During an inspection of Wards for people with a learning disability or autism Download report PDF (opens in a new tab)Download report PDF (opens in a new tab)
Inspection carried out on 5 March 2018 During an inspection of Acute wards for adults of working age and psychiatric intensive care units Download report PDF (opens in a new tab)Download report PDF (opens in a new tab)
Inspection carried out on 5 March 2018 During an inspection of Community urgent care services Download report PDF (opens in a new tab)Download report PDF (opens in a new tab)
Inspection carried out on 5 March 2018 During an inspection of Wards for older people with mental health problems Download report PDF (opens in a new tab)Download report PDF (opens in a new tab)
Inspection carried out on 5 March 2018 During an inspection of Mental health crisis services and health-based places of safety Download report PDF (opens in a new tab)Download report PDF (opens in a new tab)
See more service reports published 30 August 2018
Service reports published 13 October 2017
Inspection carried out on 18-19 July 2017 During an inspection of Acute wards for adults of working age and psychiatric intensive care units Download report PDF (opens in a new tab)
Service reports published 24 August 2016
Inspection carried out on 14 June 2016 During an inspection of Long stay or rehabilitation mental health wards for working age adults Download report PDF (opens in a new tab)
Inspection carried out on 14th-16th June 2016 During an inspection of Community-based mental health services for adults of working age Download report PDF (opens in a new tab)
Inspection carried out on 14 June – 16 June 2016 During an inspection of Acute wards for adults of working age and psychiatric intensive care units Download report PDF (opens in a new tab)
See more service reports published 24 August 2016
Service reports published 15 January 2016
Inspection carried out on 29 - 30 September and 1 October 2015 During an inspection of Mental health crisis services and health-based places of safety Download report PDF (opens in a new tab)
Inspection carried out on 28th September -2nd October 2015 During an inspection of Community end of life care Download report PDF (opens in a new tab)
Inspection carried out on 28 September- 2 October 2015 During an inspection of Forensic inpatient or secure wards Download report PDF (opens in a new tab)
Inspection carried out on 29 September 2015 to 2 October 2015 During an inspection of Community health services for children, young people and families Download report PDF (opens in a new tab)
Inspection carried out on 29 September – 1 October & 12 October 2015 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 28th September -2nd October 2015 During an inspection of Community health inpatient services Download report PDF (opens in a new tab)
Inspection carried out on 28-30 September &1-2 October 2015 During an inspection of Community urgent care services Download report PDF (opens in a new tab)
Inspection carried out on 29 September 2015 – 2 October 2015 During an inspection of Community-based mental health services for older people Download report PDF (opens in a new tab)
Inspection carried out on 29 September to 1 October and 6 October 2015 During an inspection of Acute wards for adults of working age and psychiatric intensive care units Download report PDF (opens in a new tab)
Inspection carried out on 28 September – 2 October During an inspection of Child and adolescent mental health wards Download report PDF (opens in a new tab)
Inspection carried out on 28 September – 2 October 2015 During an inspection of Wards for older people with mental health problems Download report PDF (opens in a new tab)
Inspection carried out on 28 September 2015 - 2 October 2015 During an inspection of Community health services for adults Download report PDF (opens in a new tab)
Inspection carried out on 28 September to 2 October 2015 During an inspection of Community-based mental health services for adults of working age Download report PDF (opens in a new tab)
Inspection carried out on 29 September and 1 October 2015 During an inspection of Long stay or rehabilitation mental health wards for working age adults Download report PDF (opens in a new tab)
See more service reports published 15 January 2016
Inspection carried out on 5 March 2018

During a routine inspection

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

  • Of the eight core community health and mental health services that we inspected on this occasion, we rated five as good and three as requires improvement. When we include the previous ratings of mental health and community health core services at the trust that we did not inspect on this occasion, one is rated as outstanding, 12 are rated as good and three are rated as requires improvement. In rating the trust, we have taken into account the previous ratings of the eight mental health and community health core services not inspected this time.
  • Incident reporting and investigation systems were robust in the trust.
  • The Chief Executive actively promoted research in the trust to improve the care and treatment of patients. The trust ran one of only two mental health biomedical research centres in England.
  • The trust had planned well the transfer of the learning disability services into the trust. The learning disability services were brought into the trust with care, compassion and respect for the patients, carers and staff involved.
  • Leadership at directorate level was very strong. The directorates had clear plans and strategies to improve patient care and treatment. Trust governance systems supported and encouraged the development of strong, local leadership teams.
  • The trust supported and encouraged wards and services to take part in external accreditation schemes.

However:

  • Following this inspection, we have rated one key question – safe – as requires improvement. In rating the trust, we have taken into account the previous ratings of the eight mental health and community health core services not inspected this time.
  • The trust continued to have significant issues with recruitment and retention of staff particularly qualified nurses but we were assured that the trust was undertaking key work to find new and innovative ways of attracting staff to work at the trust.
  • The community health services operated by the trust were generally rated lower than the mental health services. Staff in the community health services did not feel as embedded in the trust structure or as well supported by the trust senior teams. This issue had been identified by the trust and the directorate re-organisation due to be completed by June 2018 planned to strengthen the management and support for community health services by establishing a community health directorate.

Inspection carried out on 14-16 June 2016

During an inspection looking at part of the service

Following this re-inspection, we have reconsidered the overall rating for the trust and have now rated it good because:

  • When we undertook our comprehensive inspection in September/October 2015, we rated nine of the 14 core services provided by the trust as good and one (community health services for children, young people and families) as outstanding.This re-inspection assessed three of the core services that we had rated as requires improvement. We have now revised the ratings of these three core servces to good.
  • Following our previous inspection, the trust managers developed an action plan and worked with stakeholders to address the areas that required improvement. A group chaired by the deputy director of nursing monitored progress.This work had resulted in significant improvements in the care and treatment of patients and in the care environments.
  • The trust had developed a new estates dashboard. Any issues identified from daily environmental checks were passed to the facilities and estates management via the intranet system or telephone. The introduction of the estates dashboard had resulted in real improvements in the speed and efficiency of response.
  • When we inspected the rehabilitation ward for working age adults in September/October 2015, we rated it as requires improvement for safe, effective, responsive and well-led.Following our re-inspection, we have rated this core service as good for all key questions other than safe.The improvements that staff had made include: changes to the ward to bring it in line with the guidance on the provision of same-sex accommodation; the introduction of more personalised and holistic care plans; the removal of unnecessary blanket restrictions and improvements in ward governance.
  • In September/October 2015, we rated acute wards for adults of working age and psychiatric intensive care units as requires improvement for safe, effective, caring and well-led.Following our re-inspection, we have rated this core service as good for all key questions.The improvements include: better management of risks to patients from potential ligature anchor points; improved assessment and management of the physical health of patients and the introduction of a fuller schedule of ward activities.
  • After our inspection in September/October 2015, we rated community-based mental health services for working age adults as requires improvement for effective and well-led.We have now rated this core service as good for all five key questions.Since the previous inspection staff had improved the quality of clinical assessments and care plans.
  • Staff in all clinical areas that we visited during our recent re-inspection had high morale.
  • CQC inspectors from the Primary Medical Services directorate undertook a follow up inspection of Luther Street medical practice in April 2016. Luther Street provides primary health care services for homeless people over the age of 16 and people vulnerably housed in Oxford. Overall the practice is now rated as outstanding. It was outstanding for provision of caring and responsive services. Good for safe, effective and well led services.

However:

  • Following our comprehensive inspection in September/October 2016, we rated seven of the 14 core services as requires improvement for safe.We have not re-inspected four of these core services and have again rated the rehabilitation ward for working age adults as requires improvement for safe.

Inspection carried out on 28th September – 2nd October

During a routine inspection

We have rated the trust as requires improvement as in safe and effective. We have rated them as good for caring, responsive and well led.

On the whole services were safe, but the trust received a rating of requires improvement because we found pockets of poor practice. In addition, we found some environments that were outdated for the delivery of modern mental health care and this was of particular concern at the Warneford Hospital. There was poorly recorded risk planning in some areas of children’s services in mental health, unidentified ligature points in acute mental health services and a lack of basic life support training for reception and administration staff at the GP practice. These findings have resulted in requirement notices being issued.

Across all services the trust staff were good at recognising safeguarding concerns and reporting incidents. Teams learnt from incidents and complaints and shared learning across services, through regular ‘briefing notes’

Staff were compliant with mandatory training and had good induction programmes, as well as opportunities for continuous professional development.

The trust had a strong track record of working in partnership with the independent and voluntary sector using an integrated model to provide services. The trust is clearly committed to services that are multi-agency and multi-disciplinary and this was evident from the range os services on offer. We also observed board discussions about this and staff at the frontline described good multi-agency working.

We found that care plans were not always personalised and did not involve people in their care. In acute mental health inpatient wards this has contributed to a rating of requires improvement. The quality of care plans across the trust was variable and inconsistent. Staff at times were using both paper records and an electronic record system, as the trust moved to a new electronic health record system called Care Notes. This had been placed on the Trust risk register and they acknowledged that there were inherent risks in moving information from one system to another. They were partly mitigating these risks by implementing the new system in a phased way.

In most services, we found that staff were committed, dedicated and passionate about the work they did. Patients and their carers spoke positively about the care they received and felt they were treated with dignity and respect.

There was variability across the trust in their ability to respond to people in a timely way with some areas of outstanding practice and some where there were waiting lists for services. However, waiting lists appeared well managed and the trust were aware of these. They had actions in place to mitigate any risks this may present. There were a number of delayed discharges and bed occupancy levels were high. We found that some patients had been transferred between wards for non-clinical reasons in order to manage beds. The trust did have good systems in place for bed management but it was clear that this was a significant pressure point for the trust. Across most services there was good access to emotional support and the trust considered peoples diverse and individual needs.

Services were well led and staff were positive about local and central leadership. Mangers were visible and accessible and teams and services had the right meetings and handovers in place. Performance was monitored and reviewed. The process for monitoring of risk was robust and the board were clearly sighted on both the corporate and operational risks facing the organisation. These were presented in board meetings via a risk register. Local services also maintained local operational risk registers.

The structure of meetings and committees, which provide the board with assurance, were well embedded. Most had non-executive director oversight. This ensured that the trust have leaders who were well placed to provide the appropriate challenge.

The trust had the right policies in place to support staff in their work. Staff received relevant training and support.

There were some environmental concerns raised, which had not been dealt with in a timely way. For instance, the premises of the child and adolescent mental health services in south Oxford was in a poor condition. A leaky roof had caused substantial water damage which was reportedly highlighted 18 months ago. The smell of sewerage had been reported in a patient’s bedroom but this problem continued for over a year without resolution.

The trust achieved ratings of outstanding for ‘caring in ‘child and adolescent community services’ and primary medical services and outstanding for ‘responsive’ in ‘forensic inpatient services’ and in primary medical services. It received an overall rating of outstanding for children and young peoples’ services. These services were able to demonstrate excellent practice and innovation which went above the standards expected. For instance, in primary medical services the outreach offered to the homeless population was exceptional.

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.