- SERVICE PROVIDER
Oxford Health NHS Foundation Trust
This is an organisation that runs the health and social care services we inspect
Report from 23 June 2025 assessment
Contents
Ratings - Forensic inpatient or secure wards
Our view of the service
The date of assessment 20, 21, 27 and 28 November2024.
Oxford Health NHS Foundation Trust provides forensic/secure inpatient services for adults with mental health conditions. Patients are detained under the Mental Health Act 1983. The trust provides 153 inpatient beds across three sites, one in Oxford, one in Aylesbury and one in Milton Keynes. Littlemore Mental Health Centre in Oxford includes the Oxford clinic The Oxford Clinic has 3 medium secure wards for men. On the same site there are 4 other wards, a low secure ward for men, a Pre-discharge unit for men and women and Thames House which has two low secure wards for Women. Buckingham health and wellbeing campus has a male low secure unit and in Milton Keynes there are two male medium secure wards.
During this comprehensive inspection, we visited Kennet Ward, Kestral Ward, Kingfisher Ward and Evenlode ward at the Oxford clinic, Woodlands Ward at Aylesbury and Watling ward and Chaffron ward at Marlborough House in Milton Keynes.
During this comprehensive inspection we assessed all quality statements from the 5 key questions and found areas of good practice. We rated the service as good overall.
The senior staff team were felt to have strong presence on the wards. However staff told us that ward managers were not always present on the wards.
Ligature risk assessments were not easy to access by the staff and staff could not always tell us what the environmental risks were, and how they were working to mitigate these risks. This also meant that there was a risk that new agency or bank staff who were not familiar with the ward environment would not be shown how to successfully manage environmental risks.
The approach to managing blanket restrictions could be strengthened and we found it was being managed at senior management level rather than at a local level. This meant that staff on the wards were not always in charge of the decisions around blanket restrictions.
There were some environmental challenges that were evident in the Kennet and Kestral ward seclusion areas. Although the seclusion and long term segregation environments met the code of practice, the issues we found had a negative impact on the patients using these areas. Some patients had to request staff to let them in and out of their bedroom corridors and patients in seclusion could be seen from the corridor.
The environment at Woodlands House Aylesbury needed reviewing. The therapy rooms did not offer privacy and dignity to patients. There was a lack of natural light in the seclusion room and ability to observe a clock. We found garden areas across the services that we visited were very bland and were not seen as therapeutic spaces by the patients and staff. This was also noted at the two wards at Marlborough House. We raised this at our last inspection in 2019 and during this inspection we found this had not improved.
However, we saw strong multidisciplinary working. For example, the provider offered holistic therapeutic groups like the women’s group at Thames house which brought together elements of occupational therapy, nursing and psychological therapy. Patients had good access to various therapeutic interventions by specialists both in a group and one to one setting.
The provider had made positive progress with their international recruitment campaign and this had improved the consistency of staffing. Both patients and staff told us this had been beneficial in forming therapeutic relationships and improving relational security.
Improvements had been made to the cohesion of the multidisciplinary team and we saw consistency and transparency in the reporting of incidents of abuse.
We observed good management and auditing of restrictive practices across the wards. The teams on the medium secure wards worked with patients to reduce restrictive interventions and we saw that on Chaffron ward this had worked particularly well.
On Evenlode ward, staff used a tailored approach towards supporting the patient group and we observed good examples of this in practise.
The senior leadership team had good oversight of the wards and a good understanding of the challenges within the services and priorities for improvement. There was evidence of good oversight of the individual patient risks and environmental concerns.
We have asked the provider for an action plan in response to the concerns found at this assessment.
People's experience of this service
Overall, patients were positive about the wards across the locations. They told us that they were confident in the staff team and the ward managers and the team’s ability to keep them safe. Most patients told us they felt well informed about what was happening on the wards and were receiving the care and treatment they need. However, patients were not always fully aware of their care and treatment plans and did not always know who to go to when they wanted to discuss their care or to raise a complaint. On Kestrel ward the four patients we spoke with all felt that they did not have clear plans for moving forward or further contact from their community teams, reporting that “They keep talking about transfer but nothing happens”.
Patients told us that there was always lots to do on the wards including fishing and going to the gym and they spoke positively about the activity co-ordinators and occupational therapists on the wards.
Patients told us that they felt safe on the wards even when people are distressed, they had confidence in the staff to keep them safe. People told us they felt that most staff were doing their best to help them to improve their mental health and support them to leave hospital.