Oxford Health NHS Foundation Trust

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

This means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant the service management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

The service was in breach of regulation 17 (good governance).

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Quality Statement Score: 3

We scored the service as 3. The evidence showed a good standard. The service had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

Staff knew and understood the provider’s vision and values and how they were applied in the work of their team.

The provider’s senior leadership team had successfully communicated the provider’s vision and values to the frontline staff in this service.

Staff had the opportunity to contribute to discussions about the strategy for their service, especially where the service was changing.

Staff could explain how they were working to deliver high quality care within the budgets available.

Quality Statement Score: 3

We scored the service as 3. The evidence showed a good standard. The service had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

Leaders had the skills, knowledge and experience to perform their roles. Each ward had band 7 staff and a band 8a matron/operations lead. These staff were then supported by a senior matron who oversaw all 3 wards. These staff all had a lot of experience working in child and adolescent mental health services (CAMHS).

Staff told us that leaders above the senior matron level did not always have a good understanding of the services they managed or fully understand how CAMHS wards operate and would differ from other types of services, for example adult acute mental health wards.

Leaders were not always visible in the service. Managers told us they felt well supported by their leaders but told us that staff would not know who some of the senior leaders were.

Leadership development opportunities were available, including opportunities for staff. New managers were supported to attend leadership training.

Quality Statement Score: 3

We scored the service as 3. The evidence showed a good standard. The service fostered a positive culture where people felt they could speak up and their voice would be heard.

The provider had a Freedom to Speak Up Guardian. Managers reminded staff of this resource in team meetings and signposted them to available resources. An annual Freedom to Speak Up report was reviewed by the Trust board.

Young people and carers had opportunities to give feedback on the service they received. In the 6 months prior to the inspection there had been 131 feedback submissions across the 3 wards. Sixty-three percent of respondents on Meadow unit reported a positive experience, as did 61% of respondents from Marlborough House and 59% of respondents from Highfield unit.

Managers and staff had access to the feedback from young people, carers and staff and used it to make improvements. For example, dimmed lighting had been installed along the corridors on Highfield unit following feedback received from young people.

Quality Statement Score: 3

We scored the service as 3. The evidence showed a good standard. The service valued diversity in their workforce. They work towards an inclusive and fair culture by improving equality and equity for people who work for them.

Staff were trained in equality, diversity, inclusion and human rights.

Staff were able to apply to work flexibly e.g. flexible working agreements to account for personal circumstances such as caring responsibilities and health issues.

Managers put reasonable adjustments in place for staff members to help them carry out their role.

The provider undertook equality monitoring of staff within the service to ensure it is diverse in its make-up and representative of the patient group.

Quality Statement Score: 1

We scored the service as 1. The service did not have effective governance processes in place.

Each ward had weekly operations meetings which fed into monthly governance meetings. The governance meetings were attended by the Trust patient safety team. However, there was little evidence that any actions documented within these operations meetings had been followed up. For example, we reviewed 3 months’ worth of operations meeting minutes from Highfield unit and the actions documented were often the same month by month, with no evidence of discussion or updates on some of the identified actions.

Staff received training in how to use the electronic records system, however they recorded updates in the progress notes rather than in specific areas on the system. This meant that information in care records was difficult to find. For example, reviews for seclusion were recorded in various locations on the electronic records system. Reviews were recorded in progress notes, in a seclusion folder and paper observation sheets had been scanned and uploaded. It was not possible to tell from the records what time episodes of seclusion had begun or ended and doctors did not consistently record their reviews in the correct place, which made it difficult to see whether these had been done. Managers did not complete audits of seclusion paperwork and so these concerns had not been identified prior to the inspection. Staff were unable to find important pieces of information throughout our inspection, such as treatment authorisation paperwork for young people detained under the Mental Health Act.

The provider’s own quality assurance processes had not identified some of the concerns we identified during our inspection. For example, care plan audits had not identified that these were generic and not did not address all identified needs and the blanket restrictions review tools did not include all blanket restrictions which were in place. The provider had not identified that medicines were not always administered in line with what had been authorised.

Staff maintained and had access to the risk register at ward level. Staff at ward level could escalate concerns when required. Staff told us they reviewed the risk register in their operational meetings.

Staff had access to the equipment and information technology needed to do their work. The information technology infrastructure, including the telephone system, worked well and helped to improve the quality of care.

Quality Statement Score: 3

We scored the service as 3. The evidence showed a good standard. The service understood their duty to collaborate and work in partnership, so services work seamlessly for people. They share information and learning with partners and collaborate for improvement.

Staff understood the arrangements for working with other teams, both within the provider and external, to meet the needs of the patients. Young people with autism had care, education and treatment reviews. Young people in long-term segregation had external reviews.

Directorate leaders engaged with external stakeholders, such as commissioners. Commissioners carried out an annual quality assurance review on all wards and members of the Integrated Care Board (ICB) attended ward rounds.

Staff provided advocates with details of young people newly admitted to the wards. They also displayed information about advocacy in communal areas.

Quality Statement Score: 3

We scored the service as 3. The evidence showed a good standard. The service focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contribute to safe, effective practice and research.

Staff were given the time and support to participate in improvement projects. For example, staff on Highfield unit were involved in the culture of care programme, an initiative from NHS England to improve the care on mental health wards.

Staff had opportunities to participate in research. Staff on Meadow unit were participating in a research project around the benefits of having activity co-ordinators on the ward.

Staff used quality improvement methods and knew how to apply them. They were carrying out quality improvement projects to reduce headbanging and violence and aggression.

Staff participated in national audits relevant to the service.

Wards participated in accreditation schemes relevant to the service and learned from them. All of the wards participated in the Royal College of Psychiatrists’ Quality Network for Inpatient CAMHS (QNIC) and had received a peer review, however none were accredited.