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Provider: Northamptonshire Healthcare NHS Foundation Trust Outstanding

Inspection Summary


Overall summary & rating

Outstanding

Updated 17 December 2019

  • Since our last inspection, the trust continued to deliver high quality, safe services across the five mental health services we inspected.
  • There was a strong focus on patient and staff safety as a priority agenda. The trust had made improvements to how they learnt from investigations into serious incidents and engaged and supported families and relatives throughout the process.
  • There was a strong culture of openness, honesty and learning. There was evidence of sharing practice with others, and an ethos for embracing constant opportunity for learning and improving. The trust had formed a strong relationship with a neighbouring trust and embraced a ‘buddy’ relationship. The trust board were clear that this was not only an opportunity to support another NHS organisation, but an opportunity to improve and learn for themselves.
  • We heard how the trust had continued to prioritise their values in every interaction every day, and the culture of staff in the trust was one of kindness, teamwork and pride to work for the organisation. The trust had embedded the importance of training, supervision, talent management and development of staff. Staff had access to numerous opportunities to learn and develop within their roles.
  • All services we visited had continued to engage with carers and received positive feedback from the users of services. It was clear that co-production, involvement and engagement had continued to go from strength to strength across the trust. ‘I want great care’ continued to be integral to obtaining feedback from service users and carers.
  • We found staff completed thorough and detailed risk assessments, and the trust had effective processes for reviewing and updating them. We saw staff assessed and monitored physical healthcare well and teams had multi-disciplinary approaches that promoted healthy lifestyles. Staff completed person-centred, collaborative care plans which involved families and carers.
  • Quality improvement was embedded around the trust. The trust consistently encouraged and supported staff to innovate and develop new ideas. Staff were consulted and felt included in strategic changes and developments.
  • Staff felt valued by the trust, their managers and by each other. There was an emphasis on staff well-being and leaders saw this as a priority focus for those who worked at the trust. The board had invested in well-being events, changed policies, well-being conversations and promoted work-life balance as integral to ‘teamNHFT’. The culture was one of encouraging distributed and collected leadership throughout the trust. Staff felt supported to make decisions where appropriate.
  • Equality, diversity and inclusion had developed further since our last inspection. The trust had taken steps to promote further inclusion and collaboration of minority groups. Links with the community, the wider system and stakeholders was very strong and survey data showed an improvement in most areas of workforce equality. Directors told us that reverse mentoring had had a profound effect on their working and personal lives. The trust had robust plans for a wider roll out of this programme within the trust.
  • The trust had won several national and local awards throughout 2018 to 2019. The trust was shortlisted for other awards. The board made a conscious decision to celebrate such success internally, which positively impacted on morale of teams, staff and ultimately patient care.

However:

  • We had concerns about safe practice in isolated areas at some locations. We found an infection, prevention and control measure issue at one location, environmental concerns at both Health-based Places of Safety and high levels of restraint and seclusion in Acute Wards for adults of working age and PICU services. Across two services, we had concerns over safe management of medicines.
  • Two services had experienced organisational changes which had impacted on staff morale. The trust had plans in place to address this, but staff told us it had been a challenge.
  • Staff in Wheatfield Unit had not correctly documented Section 17 leave in 13 of 17 cases.
  • In community mental health services for people with a learning disability or autism, we found that both adults and children in the ADHD pathway, waited over 18 weeks for assessment or treatment.
Inspection areas

Safe

Good

Updated 17 December 2019

  • The trust had enough nursing and medical staff, who knew the patients and received basic training to keep people safe from avoidable harm. The number of patients on the caseloads of the mental health crisis teams, and learning disability community teams, was not too high to prevent staff from giving each patient the time they needed.
  • Staff assessed and managed risks to patients and themselves well. They responded promptly to sudden deterioration in a patient’s health. When necessary, staff worked with patients and their families and carers to develop crisis and contingency plans. Community staff monitored patients on waiting lists to detect and respond to increases in level of risk. Staff followed good personal safety protocols.
  • Staff followed best practice in anticipating, de-escalating and managing challenging behaviours. Staff achieved the right balance between maintaining safety and providing the least restrictive environment possible to support patients’ recovery. The ward staff participated in the provider’s restrictive interventions reduction programme.
  • Safeguarding people at risk was given sufficient priority by staff. Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. All staff had training on how to recognise and report abuse and knew how to apply it.
  • All teams had a good track record on safety. The service managed patient safety incidents well. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learnt within their own teams and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support.

However:

  • Incidents of restraint and seclusion had increased across the acute and PICU services compared to those at our last inspection. The restraint overall had increased by 6% and seclusion had increased by 14.5%. However, the trust had successfully reduced the use of prone restraint by 13%.
  • The physical environment of the Health-Based Place of Safety at Northampton did not meet the requirements of the Royal College of Psychiatrists standards on the use of Section 136 of the Mental Health Act 1983. The Health-Based Place of Safety at St Mary’s hospital did not have an observational panel or CCTV, in line with the Mental Health Act Code of Practice.
  • The Warren crisis house did not adhere fully to infection control principles. Staff compliance with Infection Prevention and Control training was just 70% across this core service.
  • Staff did not always follow systems and processes when safely prescribing, administering, recording and storing medicines. We identified some issues within the acute service and the community learning disability service.
  • Meadowbank ward used a number of different bank staff which led to inconsistency in care delivery. In the month prior to inspection, 27 bank shifts had been filled by 24 different people.
  • Staff compliance with manual handling training on Meadowbank ward was 63%, which fell below the trust target.

Effective

Good

Updated 17 December 2019

Caring

Outstanding

Updated 17 December 2019

  • We saw that staff across the trust treated patients with genuine levels of compassion and kindness. Patients, families, carers and stakeholders consistently gave really positive feedback about how staff treated people. We heard examples where some staff teams had delivered care which had exceeded expectations of both patients and families.
  • Staff understood the totality of individual patient need. Staff always considered people’s personal, cultural, social and religious needs when planning care and treatment. People’s emotional and social needs were highly valued by staff and respected. Staff reflected individual preferences and needs in how care was delivered.
  • The trust had truly embedded that patients were active partners in their care. Staff across the trust worked in partnership with patients and those close to them. Patients were involved in shaping their care and reviewing this regularly with the multi-disciplinary team. Staff involved patients in care planning and risk assessments. Managers had involved patients in recruitment of posts and with service development. Staff and patients continued to co-produce successful projects. Staff placed patients at the centre of everything they did. Co-production was very important to the trust.
  • Leaders actively sought feedback on the quality of the care provided across the trust. Staff empowered patients who used the service to have a voice, consistently and strongly encouraged feedback, which was acted upon. Each ward held regular patient meetings. Carers meetings were established and well attended.
  • Staff showed creativity to overcome obstacles to delivering care. They used a range of methods of communication, including easy read leaflets, information in different languages, and had access to interpreters and signers. Staff did not hesitate in seeking support from families and carers where appropriate.
  • There was a strong, visible person-centred culture. Staff were highly motivated and proud to work for the trust. Relationships between people who used the services, those close to them, and between staff were caring and supportive. These relationships were highly valued by staff and promoted by leaders.

Responsive

Good

Updated 17 December 2019

  • Patients could access the right care at the right time. Oversight of bed management was effective, and teams managed admissions and discharges well and in a co-ordinated way with others. Patients were not moved between wards or services unless this was for their benefit. Staff assessed and treated patients who required urgent care promptly. Patients who did not require urgent care did not wait too long to start treatment. Access to treatment for psychological therapies within the learning disabilities team had been improved.
  • Staff across all services planned and managed discharge well. They liaised well with services and agencies that would provide aftercare. Staff were assertive in managing the discharge care pathway. As a result, patients did not have excessive lengths of stay and discharge was rarely delayed for other than a clinical reason.
  • The trust had taken steps to reduce out of area placements significantly in the last year. Compared to data from 2018 to 2019, figures for April 2019 had reduced by 234 from 317 to 83, for May 2019 by 487 from 556 to 69 and for June 2019 by 247 from 408 to 161.  This equated to a reduction of 968 over a three-month period, which was a 76% reduction.

  • Services were easy to access. Referral criteria were clear and did not exclude patients who would have benefitted from care. The mental health crisis service was available 24-hours a day and was easy to access, including through a dedicated crisis telephone line. There was an effective local arrangement for young people who were detained under Section 136 of the Mental Health Act.
  • The design, layout, and furnishings of the wards and services supported patients’ treatment, privacy and dignity. Each inpatient had their own bedroom with an en-suite bathroom. Patients had somewhere secure to keep their personal belongings. There were quiet areas for privacy, and areas for young people to visit safely, where appropriate. Patients could make hot drinks and snacks freely and at any time. When clinically appropriate, staff supported patients to self-cater.
  • Staff encouraged and supported patients to engage with the wider community. For example, patients attended local gyms, shops, places of worship, and different cafes. The trust supported patients access education, training, as well as paid work opportunities. Staff encouraged, and facilitated where possible, contact with family members and those close to them. Patients on all wards had access to outside space.
  • The service met the needs of all patients, including those with a protected characteristic. Reasonable adjustments were made to remove barriers if people found it hard to use or access the services. Staff had the skills, or access to people with the skills, to communicate in the way that suited each patient. Staff supported patients to access advocacy services, cultural and spiritual support. The importance of flexibility, choice and continuity of care was reflected across all services.
  • The trust was proactive with treating concerns and complaints seriously. Senior staff investigated them and learned lessons from the results. Lessons learnt were shared with the immediate teams and the wider service. Staff completed investigations in a comprehensive and timely way. We saw numerous changes that had been implemented as a result of learning from complaints.

However:

  • The attention deficit hyperactivity (ADHD) and Asperger’s service had not met the trust target for referral to assessment and referral to treatment for both adults or children. The average (median) waiting time for both targets at this service was 244 days (34 weeks) against a trust target of 126 days. In the children’s pathway, 102 children waited longer than 18 weeks with 95 waiting more than 20 weeks. In the adult’s pathway, 484 patients waited longer than 18 weeks, with 262 waiting longer than 20 weeks. The trust had plans in place to reduce waiting lists by early 2020.  
  • Patients and staff at the Wheatfield unit, told us that the quality and variety of food was poor. 

Well-led

Outstanding

Updated 17 December 2019

  • The absolute clarity of culture and leadership made it easy for staff, patients and stakeholders to understand what the trust did. The trust had a firmly embedded vision, values and strategy ‘road map’ which strongly underpinned the eight domains of the well-led key question.
  • Leaders had an inspiring shared purpose and strived to deliver and motivate staff to succeed. There was compassionate, inclusive and effective leadership. Leaders had an in-depth understanding of services they managed, including the issues, challenges and priority of their services. They explained clearly how each team worked to provide high quality, safe care. Leaders were visible and approachable for staff, patients and carers.
  • Staff knew and understood the provider’s vision and values and how these applied in the work of their teams. All staff were passionate, caring, focused on putting patients first, and viewed patient recovery as a priority. Staff consistently displayed the values in their interactions with colleagues, patients and carers.
  • We heard many examples of quality improvement and innovation that had a wide-reaching impact for staff and patients. Staff collected analysed data about outcomes and performance and engaged actively in local and national quality improvement activities. Improvement methods and skills were available and used across the trust. Staff were empowered to lead and deliver change. The trust had an ethos of sharing work and learning from others
  • Our findings from the other key questions demonstrated that governance processes operated effectively at team level. Staff managed performance and risk well. Teams had access to the information they needed to provide safe and effective care and used that information to good effect.
  • There was a strong focus on patient and staff safety as a priority agenda. The trust had made improvements to how they learnt from investigations into serious incidents and engaged and supported families and relatives throughout the process.
  • The organisational wide approach, culture and practice of co-production continued to grow from strength to strength. The opportunities for staff, patients, carers and stakeholders to be part of service delivery and innovation were extensive.
  • We saw numerous examples of very effective use of information that steered decision making and priority setting across the trust.
  • The trusts’ approach to Freedom to Speak Up, equality, diversity, inclusion and cultural expectations of how staff behaved was well advanced. This underpinned how the trust operated internally and in the wider system.
  • We were aware of how extensive the board involvement and influence had in the wider system to direct and lead system discussion, planning and performance to the benefit of people in the county.
  • We were impressed by how the trust continued to celebrate success, internally and externally, and saw how a conscious decision to do so, had a clear and positive impact on improving and sustaining staff morale.
  • Staff across the trust felt respected, supported and valued in their teams. The trust promoted equality, diversity, inclusion and wellbeing within day to day work. Staff had ample opportunities for further development and career progression. Staff felt able to raise concerns or challenge senior staff without fear of retribution. The trust placed a strong emphasis on staff well-being and leaders saw this as a priority focus for those who worked at the trust. The board had invested in well-being events, changed policies, well-being conversations and promoted work-life balance as integral to ‘teamNHFT’.
  • We heard about the work the board had done with governors to develop relationships and embed their position with the board had been effective and valued by all those we spoke with.
  • There was a strong culture of openness, honesty and learning. There was evidence of sharing practice with others, and an ethos for embracing constant opportunity for learning and improving. The trust had formed a strong relationship with a neighbouring trust and embraced a ‘buddy’ relationship. The trust board were clear that this was not only an opportunity to support another NHS organisation, but an opportunity to improve and learn for themselves.

However:

  • Oversight of both safe management of medicines and levels of restraint and seclusion, required improved governance and targeted action.
Checks on specific services

Long stay or rehabilitation mental health wards for working age adults

Good

Updated 17 December 2019

  • The service provided safe care in a safe and clean environment. The wards had enough nurses and doctors to operate safely. Staff assessed and managed risk well. They minimised the use of restrictive practices, managed medicines safely and followed good practice with respect to safeguarding.
  • Managers dealt with staff sickness in line with provider policy. There was enough staff to maintain patient safety on the ward, and managers were aware of the pressures on other staff members due to gaps in some roles. We saw quality improvement plans developed to address the issues.
  • Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. Staff provided a range of treatments suitable to the needs of the patients, which were in line with national guidance about best practice. Staff engaged in clinical audit to evaluate the quality of care they provided.
  • The ward staff had access to a range of specialists required to meet the needs of patients. Managers ensured that these staff received training, supervision and appraisal. The ward staff worked well together as a team and with those outside the ward who would have a role in providing aftercare.
  • Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. They actively involved patients and families and carers in care decisions, and actively promoted co production whenever possible.
  • Staff planned and managed discharge well and liaised with services that would provide aftercare. As a result, discharge was rarely delayed for other than a clinical or Ministry of Justice reason.
  • The service worked to a recognised model of mental health rehabilitation. It was well-led and the governance processes ensured that ward procedures ran smoothly.

However:

  • Managers had not ensured the multidisciplinary staffing establishment met the needs of patients. This followed an increase in patient numbers and the reassignment of a key post. There was significant long-term sickness on the ward, which resulted in high usage of bank staff.
  • The patients self-catering kitchen was not clean, and there was no effective system for ensuring that this kitchen was cleaned after every use.
  • Manual handling training compliance was 63%, which fell below the trust target.

Community mental health services with learning disabilities or autism

Good

Updated 17 December 2019

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

  • The service provided safe care. The clinical environments were generally safe and clean. The teams had enough nurses and doctors. Staff assessed and managed risk well. Staff managed most medicines safely and followed good practice with respect to safeguarding.
  • Staff developed holistic, care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the patients and in line with national guidance and best practice. Staff engaged in clinical audit to evaluate the quality of care they provided.
  • The teams included or had access to the full range of specialists required to meet the needs of patients. Managers ensured that these staff received training, supervision and appraisal. The ward staff worked well together as a multidisciplinary team and with those external to the teams and trust who had a role in providing care. Staff planned and managed transitions and discharges well and liaised well with external agencies.
  • Staff understood and discharged their roles and responsibilities the Mental Capacity Act 2005. They followed good practice with respect to young people’s competency and capacity to consent to or refuse treatment. Staff understood their roles and responsibilities under the Mental Health Act 1983, although there were no patients subject to any section of the Mental Health Act during inspection.
  • Staff treated patients with high levels of compassion and kindness, truly respected their privacy and dignity, and fully understood the individual needs of patients. They actively involved and collaborated with patients, families and carers in care decisions. People who used services were always fully involved in writing their care plans and action plans. Staff consistently provided care plans and treatment information in easy read and visual formats. The service routinely encouraged involvement and feedback from people who used service and their carers including recruitment of staff.
  • The service was well led, and the governance processes ensured that ward procedures ran smoothly.

However:

  • Due to organisational changes, and a change in the staff group since the last inspection, some staff described ‘significant niggles’ and difficulties in the team. Organisational changes had had an impact on the morale of some staff.
  • Only 53% of staff had attended Mental Capacity Act training. Therefore, the trust had not met its target of 90%.
  • The attention deficit hyperactivity (ADHD) and Asperger’s service had not met the trust target. The waiting time for this service was 244 days (34 weeks) against a trust target of 126 days.

Mental health crisis services and health-based places of safety

Good

Updated 17 December 2019

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

  • There were a number of innovative ways people could access support for crisis care across the county. The crisis cafés had become overwhelmingly popular and alongside the crisis house, had reduced the number of admissions to acute wards, and attendances at local accident and emergency departments. The treatment pathway and access to crisis services in the county was exemplary and had been recognised for national awards.
  • The mental health crisis service was available 24-hours a day and was easy to access, which included a dedicated crisis telephone line. The referral criteria for the mental health crisis teams did not exclude patients who would have benefitted from care. Staff assessed and treated patients thoroughly and promptly. Staff consistently followed up with patients who missed appointments.
  • The mental health crisis care pathways were committed to improving crisis services for the public by ensuring current and future services were informed by the feedback of service users and carers.
  • Staff were overwhelmingly positive and passionate about their roles and the client group they supported. Staff felt highly valued by the leaders within the service, who themselves were dynamic. Staff felt very proud about working for the trust and within their teams. Patients told us staff listened to their choices and went “the extra mile”. Patients told us heartfelt stories about the care they had received had exceeded their expectations.
  • Leaders within the service had an in-depth understanding of the service. They had the skills, knowledge and experience to perform their roles effectively. They explained clearly how the teams worked to provide high quality care. Leaders had an inspiring shared purpose, strived to deliver high quality and safe care, and motivated staff to succeed.
  • Staff thoroughly assessed and managed risks to patients and themselves. They responded promptly to any sudden deterioration in a patient’s health. When necessary, staff in the mental health crisis teams and the psychiatric liaison mental health services, worked in collaboration with patients, families and carers to develop crisis plans.
  • Staff assessed the mental health needs of all patients. Staff routinely worked with patients, families and carers to develop individual care plans and updated them when needed.
  • The crisis pathway at the trust had been awarded national recognition for the services provided and develop in collaboration with patients.

However:

  • The physical environment of the Health-Based Place of Safety at Northampton did not meet the requirements of the Royal College of Psychiatrists standards on the use of Section 136 of the Mental Health Act 1983. The room could not be observed externally and required staff to enter the room to observe patients effectively. At times, staff observed patients with the door ajar and some attempts by patients to abscond from the room when aggressive, led to episodes of restraint.
  • The Health-Based Place of Safety at St Mary’s hospital did not have an observational panel or CCTV, in line with the Mental Health Act Code of Practice. Access to the room in an emergency, could not be gained via a second door.
  • The Warren crisis house did not adhere fully to infection control principles. Patients’ personal bathing items were stored together in a shared bathroom. Infection Prevention and Control training was low across this core service at 70% which was below the trust target of 90%.

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

Good

Updated 17 December 2019

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

  • The service provided safe care. The ward environments were safe and clean. The wards had enough nurses and doctors to meet the needs of patients. Staff assessed and managed risk well. They minimised the use of restrictive practices and followed good practice with respect to safeguarding.
  • Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the patients which were in line with national guidance and best practice. Staff engaged in clinical audits to evaluate the quality of care they provided.
  • The ward teams included or had access to the full range of specialists required to meet the needs of patients. Managers ensured that these staff received training, regular supervision and an annual appraisal. The ward staff worked well together as a multidisciplinary team, and with those outside the ward who would have a role in providing aftercare.
  • Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. They actively involved patients and families and carers in care decisions.
  • The service managed beds well. A bed was almost always available locally to a person who needed admission. Patients were discharged promptly once their condition warranted this.
  • The service was well-led. Governance processes were established and ensured that ward procedures ran smoothly. Innovative ideas to reduce restrictive interventions had made a positive impact on patient care.

However:

  • Staff did not always follow systems and processes when safely prescribing, administering, recording and storing medicines.
  • Incidents of restraint and seclusion had not reduced since our last inspection.

Forensic inpatient or secure wards

Outstanding

Updated 17 December 2019

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

  • There was a truly holistic approach to assessing, planning and delivering care and treatment to all people who used services. We saw safe use of innovative and pioneering approaches to care delivery. New evidence-based technologies were used to support the delivery of high quality care. Staff provided a range of treatment and care for patients based on national guidance and best practice. They ensured that patients had good access to physical healthcare and supported them to live healthier lives.
  • The continuing development of the staff’s skills, competence and knowledge was recognised as being integral to ensuring high-quality care. Staff were proactively supported and encouraged to acquire new skills, use their transferable skills, and share best practice. Staff, teams and services were committed to working collaboratively and had found innovative and efficient ways to deliver more joined-up care to people who used services. Staff from different disciplines worked together as a team to benefit patients.
  • The leadership, governance and culture were used to drive and improve the delivery of high-quality person-centred care. Leaders encouraged innovation and participation in research. Leaders had an inspiring shared purpose and strived to deliver and motivate staff to succeed. There were high levels of satisfaction across all staff.
  • The service provided safe care. The ward environments were safe and clean. The wards had enough nurses and doctors. Staff assessed and managed risk well. They minimised the use of restrictive practices, managed medicines safely and followed good practice with respect to safeguarding.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. They actively involved patients and families and carers in care decisions.
  • Staff planned and managed discharge well and liaised with services that would provide aftercare. As a result, discharge was rarely delayed for other than a clinical reason.

Community health services for adults

Good

Updated 16 August 2018

The summary for this service appears in the overall summary of this report.

Community-based mental health services for older people

Outstanding

Updated 16 August 2018

The summary for this service appears in the overall summary of this report.

Community-based mental health services for adults of working age

Good

Updated 16 August 2018

The summary for this service appears in the overall summary of this report.

Community health inpatient services

Outstanding

Updated 16 August 2018

The summary for this service appears in the overall summary of this report.

Community health services for children, young people and families

Good

Updated 28 March 2017

Overall rating for this core service Good

Overall, we rated the children, young people and family service as good. We found that:

  • Despite staffing pressures due to vacancies, staffing levels generally met patients’ needs at the time of the inspection.

  • Staff understood their responsibilities to raise concerns and record and report safety incidents, concerns and near misses and adhered to safeguarding policies and procedures.

  • For staff training, the overall compliance rate was 88% and this was comparable to the trust target of 90%.

  • Individual care records were written in a way that kept patients safe from avoidable harm. For example, records were maintained on the trust’s electronic record system and staff were able to access the system and update records.

  • Generally, arrangements for the handling of medicines kept people safe from avoidable harm. The servicing arrangements for equipment were generally effective.

  • There were reliable systems in place to prevent and protect patients from healthcare associated infection.

  • Care and treatment were planned and delivered in line with current evidence based guidelines, standards, best practice, and legislation.

  • Clinical audits were undertaken and outcomes used to drive improvements in the service.

  • The service delivered all aspects of NHS England’s Healthy Child Programme and had Baby Friendly Initiative breastfeeding stage 2 accreditation.

  • Staff had the skills, knowledge, and experience to deliver effective care and treatment.

  • There were suitable arrangements in place to enable staff to receive professional development, supervision and appraisal. Multiagency working across teams was positive and effective.

  • Staff worked together to assess and plan ongoing care and treatment in a timely way when patients moved between teams or services, including referral, discharge and transition.

  • Consent was obtained in line with legislation.

  • Staff involved children, young people and those close to them in all aspects of their care and treatment.

  • Staff were committed to empowering young people and provided them with appropriate information and support to enable them to make decisions around the care they received.

  • The service reflected the needs of the local population and provided flexibility, choice and continuity of care to meet needs of the local community.

  • Generally, patients had timely access to initial assessment, diagnosis or urgent treatment.

  • There were positive adjustments in place when monitoring and responding to patients with a learning disability.

  • Complaints’ processes were effective.

  • Front line staff described their senior managers as being supportive, visible and approachable and provided an open door policy.

  • Staff were aware of the vision and strategy for children and young people’s services and supported the changes to provide a more child centred service.

However, we also found that:

  • Arrangements for storing some medicines, such as vaccines storage in cool boxes, did not always keep people safe. Staff took immediate action to address this concern.
  • The service undertook child protection medical assessments but had no standard operating procedure for these assessments.

There were 233 children waiting on the attention deficit hyperactivity disorder waiting list and 127 patients on the autism spectrum disorder waiting list. However, the number of children on the waiting list had reduced and there was an action plan in place to monitor the waiting list.

Specialist community mental health services for children and young people

Good

Updated 28 March 2017

We rated specialist community mental health services for children and young people as good because:

  • All patients using the service had a comprehensive risk assessment and care plan, which was regularly reviewed and updated.

  • The service protected children and young people from abuse through clear safeguarding policies and procedures.

  • The service complied with local safeguarding children board procedures and appropriate national guidance.

  • Staff, including temporary staff, had undergone a Disclosure and Barring Service check (or local equivalent) and were checked against the Protection of Children Act register before appointment.

  • Staff used nationally recognised assessment tools.For example, the child and young people self-harm pathway, and completed integrated assessments with acute hospital staff.

  • Staff provided a range of therapeutic interventions in line with National Institute for Health and Care Excellence (NICE). For example cognitive behaviour therapy provided by Improved Access to Psychological Therapies training practitioners.

  • Regular team meetings took place, and staff told us they felt supported by colleagues.

  • Young people and their carers reported they were treated with dignity and respect and gave positive feedback about staff.

However:

  • Interview rooms were not fitted with alarms at any of the locations we visited. Staff mitigated this by always telling colleagues where they were and who they were with. Managers had not completed ligature audits in any of the locations we visited.

  • Two of the first aid boxes we inspected at Isebrook Hospital and Sudborough House had out of date materials in them, such as bandages.

  • One patient we spoke with told us they were kept waiting for an hour for an appointment

  • Interview rooms appeared to have adequate sound proofing for normal rate and volume speech, but if voices were raised this could be heard outside of the interview room, meaning that in those cases confidentiality may not be maintained.

Community dental services

Outstanding

Updated 28 March 2017

Overall rating for this core service

We rated the community dental services at this trust as outstanding.

  • We found staff to be hard working, caring and committed to the care and treatment they provided. Staff spoke with passion about their work and conveyed their dedication in what they did.
  • The community dental service was well led. We saw a service that had strong and effective clinical leadership at its heart and there were effective governance and risk management structures in place. We found a local operational management team that was effective and visible and the working culture appeared open and transparent.
  • We saw that the way staff delivered care and organised the running of the service embodied the organisation’s overall vision of how care should be delivered. Staff told us they were well supported by the management team and that they could raise any concerns at any time and reported that their concerns were always dealt with in a timely manner.
  • Staff protected patients from abuse and avoidable harm. We saw that there were effective systems in place for identifying, investigating and learning from patient safety incidents. Effective infection control procedures were in place and followed published guidance in relation to primary care dental services. We observed an environment and equipment that was clean and well maintained and medicines and emergency equipment were available at each site we inspected to deal with medical emergencies.
  • The dental services were effective and focused on patients’ and their oral health care. The care provided followed current professional guidance in relation to special care dentistry, best practice prevention, general anaesthesia and conscious sedation.
  • To help address the needs of more vulnerable members of the community in Northamptonshire we saw an effective and outward facing oral health promotion unit led by an enthusiastic and committed clinical lead. For example, this service reached out to vulnerable groups in care homes, adults with a learning difficulty, homeless, those with drug and alcohol dependence, those living with dementia and chronic obstructive pulmonary disease support groups. We saw a comprehensive package of training that had been developed by the clinical lead to assist care home workers in maintaining good oral health to the residents in the care home.
  • Staff responded to patients’ needs at each clinic we inspected. The service kept treatment delays for routine dental treatment within reasonable limits through effective resource management. Effective multidisciplinary team working ensured the service provided patients with care that met their needs, at the right time and in the right place.
  • Patients, relatives and carers reported that they had positive experiences of care within the service. We saw good examples of staff providing compassionate and effective care. We also saw effective interactions taking place between individual staff members which resulted in a happy yet calm working environment.

End of life care

Good

Updated 28 March 2017

We rated end of life care services at this trust as good overall because:

  • Patients were protected from avoidable harm. Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. Arrangements to minimise risks to patients were in place.

  • Patients were protected from abuse; staff had an understanding of how to protect patients from abuse and could describe what safeguarding was and the process to refer concerns.

  • Patients received effective care and treatment that reflected current evidence-based guidance, standards and best practice.

  • Patients had comprehensive assessments of their needs, which included nutrition and hydration and physical and emotional aspects of their care.

  • Care from a range of different staff groups was coordinated effectively; there was effective multidisciplinary working, with staff, teams and services at this trust working in partnership to deliver effective care and treatment.

  • Staff understood the consent and decision making requirements of legislation and guidance, including the Mental Capacity Act 2005; this was reflected in the Do Not Attempt Cardio-Pulmonary Resuscitation orders reviewed during our inspection.

  • The care provided to patients in the end of life care service was good. Patients were truly respected and valued as individuals and were empowered partners in their care.

  • Feedback from patients, relatives and carers was consistently positive and there were many examples of staff being caring, compassionate and providing dignity in a respectful manner.

  • Patients’ needs were mostly met through the way end of life care was organised and delivered.

  • The service was evolving, with a developing strategy. There were robust mechanisms in place to share learning across end of life services.

However,

  • The trust did not collect data to establish how rapidly patients were discharged from inpatient services and how often delayed discharges occurred.

Child and adolescent mental health wards

Outstanding

Updated 28 March 2017

We rated child and adolescent inpatient wards as outstanding because:

  • Patients’ care, treatment and support achieved good outcomes, promoted a good quality of life and was based on best practice. Staff actively monitored and reviewed consent practices to ensure that patients were involved in making decisions about their care and treatment.
  • Staff identified ligature points on an environmental audit and took actions to reduce the risk to patients. These included enhanced observation levels. Wards complied with the Department of Health’s guidance of eliminating mixed sex accommodation, which meant that the privacy and dignity of patients was upheld.
  • Staffing levels were appropriate to meet the needs of patients. Staff said leave and activities were very rarely cancelled or rearranged because of staff shortages.
  • Staff completed comprehensive assessments for patients, which they completed in a timely manner in collaboration with the patient and their families where appropriate. We looked at 12 care plans, the patient, reviewed and signed them, they were up to date, personalised, holistic, recovery orientated and included physical health checks. Specialist training was available to staff and supported by the trust, this included two members of staff undertaking a master’s degree in working with patients with eating disorders and two support workers who were advanced apprentices. Staff said they felt supported to maintain their continuing professional development.
  • The service held a yearly “rivers of experience” event. Patients and parents who had used the service over the preceding 12 months were invited to attend a meeting whereby they were encouraged to share their experience, contribute to developing the service and to look at where things could have been done differently.
  • Patients told us that they had good relationships with staff and they were very helpful, understood their problems and were always available. They said they felt safe and staff took the time to listen to them when they had a problem.
  • The service held a yearly “rivers of experience” event. Patients and parents who had used the service over the preceding 12 months were invited to attend a meeting whereby they were encouraged to share their experience, contribute to developing the service and to look at where things could have been done differently.
  • Staff gave patients information on how to make a complaint. We saw information around the units about how to make a complaint. Patients said they felt they could make a complaint if they wanted.
  • Staff reported extremely positive morale and job satisfaction. They reported good relationships with managers and felt empowered in their roles.
  • The trust was supporting the service, in collaboration with Northampton University with a poster presentation at a conference in Geneva in 2017.

However:

  • Staff had secluded a patient for a prolonged period of time. The patients’ notes showed that staff had reviewed the episode of seclusion as per the trust policy. However, we could not establish what the outcome of the review was or why the decision was made to continue the seclusion.
  • Patients did not have a lockable cupboard in their room.

Wards for older people with mental health problems

Good

Updated 28 March 2017

We rated wards for older people with mental health problems as good because:

  • The ward environments were clean and tidy, which patients confirmed was always the case.

  • Patients confirmed that staff were available to them on the wards. Leave or activities were not cancelled due to staffing shortages.

  • Patients said that they felt safe.

  • Staff completed detailed risk assessments for patients on admission and reviewed them regularly.

  • Staff monitored patients’ physical health regularly from the point of admission.

  • Staff were warm in their interactions, quick to respond in a kind and caring manner.

  • Patients and carers were encouraged to be involved in their care and they knew how to complain if needed.

  • There was a range of treatments and activity delivered by skilled and experienced staff.

  • Staff reported good morale, felt they were supported by managers and were happy in their roles.

  • We reviewed 39 prescription charts and saw generally good management of medication on Brookview, Spinney and Orchard wards. Medication was prescribed within recommended guidance and most documentation was present and in date.

However:

  • On Riverside ward we found a number of missed medication doses and staff did not always report using the incident reporting system.

  • Not all care plans were recovery focused or personalised and some paperwork had gaps.

  • Mental capacity assessments were not documented in detail and lacked evidence of family or Independent Mental Capacity Act Advocate involvement.

  • Some patients reported that they would like a television in their bedrooms.

Substance misuse services

Outstanding

Updated 4 September 2015

We have rated substance misuse services as Outstanding because:

  • The service was safe. It had an appropriate number of rooms for patients to be seen in. The locations were clean and had resuscitation equipment, which was checked regularly. Staff had been appropriately trained to carry out their roles.
  • The service was effective. They made appropriate assessments and were responsive to changing patient needs. NICE guidelines were used to ensure best practice and multi-agency teams worked well together.
  • The service was exceptionally caring. Staff viewed patients in a positive way and were person centred in their approach. The service was recovery focused and had developed pathways with other agencies to build on recovery capital for patients who used the service. All the patients spoken to felt they had benefited from the service and told us how caring staff were.
  • The service was responsive. There were no waiting lists for treatment, all patients were seen within two weeks of referral and many the same day. The service had meaningful service user involvement and held weekly service user forums as well as a peer mentoring scheme.
  • The service was well led. There was a clear vision for the service which staff understood. Staff told us they felt senior management were visible and they felt listened to and valued. There was evidence of regular supervision, appraisal and performance management. Morale amongst the staff team was good.

Wards for people with a learning disability or autism

Good

Updated 26 August 2015

We gave an overall rating for wards for people with learning disabilities as good because:

  • There were robust risk assessments and plans in place to keep patients safe.
  • Staffing levels were appropriate to need.
  • There was good multi-disciplinary working within the teams and between other services.
  • Staff showed a good understanding of the Mental Health Act and Mental Capacity Act.
  • There were effective methods for obtaining feedback from service users and carers and feedback was acted upon.
  • Staff were caring and committed to providing high quality care and showed a person-centred approach.
  • Staff received regular supervision and all had received an appraisal in the last 12 months.
  • The local managers monitored the environment, carried out local audits and checked the performance of staff on a regular basis.

However: -

  • One of the four wards visited, the learning disability assessment and treatment unit, was not fit for purpose. It was recognised there was a plan to move to an alternative site in July 2015.The trust recognised the importance of ensuring that safety was maintained at this location. This included taking measures to ensure the physical safety of patients and staff, providing sufficient training for all staff, including bank or agency staff, and ensuring on-going leadership support to the recently appointed manager.
  • There was sometimes a delay when the personal alarm system was activated.
  • The same medicine cards were used for each stay at the short breaks wards. This resulted in gaps in the signature section which could cause confusion.