• Organisation
  • SERVICE PROVIDER

Oxford Health NHS Foundation Trust

This is an organisation that runs the health and social care services we inspect

Overall: Good read more about inspection ratings
Important: Services have been transferred to this provider from another provider

All Inspections

30th July 2019 to 25th September 2019

During an inspection of Community urgent care services

Our rating of this service improved. We rated it as good because:

  • Staff treated patients with compassion, kindness and respect. They understood patients’ specific needs and helped them make decisions about their care and treatment.
  • Services were delivered to meet the needs of local people, and staff worked well with others in the wider health and care system to plan patients’ individual care.
  • There was effective leadership and senior managers developed the service vision and strategy, with engagement with partners in health and social care. The governance arrangements supported improvements in service quality. Leaders and staff understood the key risks and risks were managed and escalated appropriately.
  • The services were delivered based on national guidance and evidence-based practice. Staff carried out audits to ensure they followed best practice.
  • Staff reported and learnt from incidents.
  • Services were delivered in accessible premises and planned to provide convenient care, close to people’s homes. Equipment was safety checked and was in good condition. Medicines were well-organised, stored safely and at the right temperature, and staff protected people from infections by keeping the environment and equipment clean.
  • Staff completed and updated risk assessments for each patient and kept clear records.
  • The services sought patient feedback and had systems to manage and respond to complaints.
  • Safeguarding training targets had been met. All staff had received an appraisal within the last year. The majority of staff had completed mandatory training required by the trust although a small number of staff had not completed training in key clinical skills.
  • There was a positive and caring working culture. Staff respected the patients, their colleagues and managers. They responded kindly if patients were afraid or distressed. Staff understood the need for some patients to have privacy or a quiet space.
  • Clinical leaders were respected by staff. They were knowledgeable about quality issues and priorities, understood what the challenges were and took action to address them.

However

  • The service had a number of permanent staff vacancies. Leaders had identified this as a key risk and were continuing to recruit additional staff and offered in-house training to attract new staff from a range of clinical backgrounds.
  • At Henley and Witney staff had difficulty observing patients due to the layout of the waiting areas. There was a risk that staff might not observe patients who deteriorated and needed prioritised care.
  • Staff told us they found it difficult to access supervision.

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.

18-19 July 2017

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

We inspected the safe, effective and well led key questions and found the following areas of good practice:

  • The ward environment was in very good condition and kept clean.

  • There was good medicine management in place with strong oversight by the pharmacy team. Emergency medicine and equipment was checked and in date.

  • The ward had well-formulated and patient-centred care and treatment plans. Risk assessments and risk summaries were thorough and were updated regularly in response to incidents and changes.

  • Ward rounds were inclusive, comprehensive and patient-centred. There was a focus on discharge planning from the start of admission and reviews included discussions with patients regarding their responsibility for their safety on discharge.

  • Staff told us that despite the staffing challenges, they felt part of a very strong, supportive team. Patients and staff had positive comments about other staff members including senior managers.

  • Patients and their carers had access to a range of information and support to encourage them to participate in their care.

However, we also found areas that the service provider could improve:

  • Recruitment challenges and staff sickness meant that there was a high use of agency nurses on the ward. This meant that care was not always delivered to the highest standard. Staff members and patients told us they sometimes felt unsafe when there were mainly staff on duty who were unfamiliar with the ward and the patients.

  • There has been a lack of consistency in the senior leadership of the ward over the previous 18-24 months due to locum posts and turnover of senior team members. However, the trust was taking action to improve recruitment and retention of staff.

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.

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.

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.