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Provider: Lincolnshire Partnership NHS Foundation Trust Good

Inspection Summary


Overall summary & rating

Good

Updated 22 June 2020

We have not updated trust-level ratings following this core service inspection because we were not able to complete the trust-level well-led inspection. This is due to suspension of routine inspections during the COVID-19 pandemic. Refer to the previous inspection report for the detailed findings on which the ratings are based.

Inspection areas

Safe

Good

Updated 22 June 2020

We have not updated trust-level ratings following this core service inspection because we were not able to complete the trust-level well-led inspection. This is due to suspension of routine inspections during the COVID19 pandemic. Refer to the previous inspection report for the detailed findings on which the ratings are based.

Effective

Good

Updated 22 June 2020

We have not updated trust-level ratings following this core service inspection because we were not able to complete the trust-level well-led inspection. This is due to suspension of routine inspections during the COVID19 pandemic. Refer to the previous inspection report for the detailed findings on which the ratings are based.

Caring

Good

Updated 22 June 2020

We have not updated trust-level ratings following this core service inspection because we were not able to complete the trust-level well-led inspection. This is due to suspension of routine inspections during the COVID19 pandemic. Refer to the previous inspection report for the detailed findings on which the ratings are based.

Responsive

Good

Updated 22 June 2020

We have not updated trust-level ratings following this core service inspection because we were not able to complete the trust-level well-led inspection. This is due to suspension of routine inspections during the COVID19 pandemic. Refer to the previous inspection report for the detailed findings on which the ratings are based.

Well-led

Outstanding

Updated 22 June 2020

We have not updated trust-level ratings following this core service inspection because we were not able to complete the trust-level well-led inspection. This is due to suspension of routine inspections during the COVID19 pandemic. Refer to the previous inspection report for the detailed findings on which the ratings are based.

Checks on specific services

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

Good

Updated 16 January 2019

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

Long stay or rehabilitation mental health wards for working age adults

Good

Updated 22 June 2020

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

Community mental health services with learning disabilities or autism

Good

Updated 16 January 2019

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 January 2019

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

Specialist community mental health services for children and young people

Outstanding

Updated 9 June 2017

We rated Lincolnshire Partnership NHS Foundation Trust specialist community mental health services for children and patients as outstanding because:

  • Patients and carers told us that everyone was caring, compassionate, kind and treated them in a respectful manner. All feedback surveys collected by the trust were consistently positive about the way that staff treated patients.

  • The service had established an innovative model of working using outcome measures at each appointment. This model was patient centred and holistic based around the child or young persons’ strengths and goals.

  • Staff were open and transparent in relation to incidents and complaints. They acted on lesson learnt from incidents and complaints. They strived to continually improve the service they delivered by working closely with commissioners and other stakeholders.

  • Managers and senior staff including board members were visible and approachable. Staff expressed they felt able to raise concerns without fear of reprisal. The managers and team co-ordinators were passionate about delivering high quality care and treatment and had funded 17 clinicians to undertake children and young people’s improving access to psychological therapies training. They had managed to recruit to the 17 vacancies with substantive posts therefore increasing the level of staffing within the service.

  • Risk assessments and care plans were comprehensive and well written. They were developed in collaboration with the patient and, where appropriate, their carers. Staff were able to refer patients to the crisis and home treatment and resolution service within CAMHS if they were concerned about a young person’s presentation out of hours and at weekends. This service had been praised highly by senior staff at the local hospitals in relation to the responsiveness of the team Communication between the teams was excellent.

  • The service had introduced an animal assisted therapy service to group work for patients.

However:

  • Only 68% of staff had undertaken the children’s safeguarding training level 3B.This was below the trust target of 95%.

  • Staff supervision rates were lower than the trust expectations and managers did not always keep a record of supervision sessions.

Mental health crisis services and health-based places of safety

Good

Updated 9 June 2017

We rated mental health crisis services and health-based places of safety as ‘good ‘because:

  •  The trust had taken actions to improve the environment of the health based place of safety and to increase the range of multi-disciplinary staff in crisis teams following our last inspection.

  • Staff completed risk assessments for all patients and updated them as the level of risk changed.

  • Many patients felt their mental health had improved as a result of the service they received from the crisis and home treatment teams.

  • The trust took action to address the changes to the Policing and Crime Act 2017 and had identified inpatient beds to ensure patients were not kept longer in the health based place of safety than needed.

  • Managers reviewed discharge processes for inpatients to ensure they did not remain in hospital longer than was needed. For example, they reviewed the use of the crisis house, improved communication with discharge coordinators and bed managers.

  • The trust arranged crisis team support based out of hours with the police to signpost patients to mental health services.

  • The trust met commissioned targets for contacting patients within four hours.

  • The trust had plans to develop a clinical decisions unit in 2018 to further support patients in crisis needing hospital admission.

  • Grantham crisis and home treatment team had achieved the Royal College of Psychiatrists home treatment accreditation scheme.

However

  • The trust had not ensured that staff regularly received clinical and managerial supervision.

  • Patients and carers did not have copies of their care plans explaining the support teams would give them.

  • Staff did not consistently document that they had assessed patients’ physical health care needs.

  • Crisis team staff said that patients could wait for hours to be transferred to out of area placements due to delays with the contacted transport service being able to respond and escort them.

  • Crisis teams did not include psychologists which meant assessments of patients at the point of crisis were not fully multi-disciplinary.

  • Staff morale in Louth was lower than other teams because of increased work due to the community mental health teams and difficulty accessing medical cover.

  • The trust had not ensured that all staff completed mandatory training for their role.

  • Trust information from April 2016 to March 2017 showed staff had not completed the patient’s discharge time on records on 127 occasions.

Wards for older people with mental health problems

Good

Updated 9 June 2017

  • Ligature points (places to which patients intent on self-harm might tie something to strangle themselves) were identified as part of the monthly environmental risk assessment audit and actions had been identified to reduce the risk to patients. These included enhanced observation levels. Wards complied with the Department of Health’s eliminating mixed sex accommodation guidance, which meant that the privacy and dignity of patients was upheld.
  • Cleaning rotas had been completed and the wards were visibly clean and tidy. Nurse call systems were in place in bedrooms, communal and office areas.
  • Staffing levels were appropriate to meet the needs of patients. There were low levels of both qualified and unqualified nursing vacancies. Ward managers were able to adjust staffing levels to take account of clinical need and said senior managers never refused a request for additional staffing if required. Escorted leave and activities were rarely cancelled due to staff shortages.
  • Staff followed National Institute for Health and Care Excellence (NICE) guidelines in relation to practice and when prescribing medications. These included regular reviews and physical health monitoring. Patients were supported to access specialists when required for physical healthcare needs. Hydration and nutrition were monitored regularly and recorded in care records.
  • Staff and patients interacted well. Staff managed distressed patients in a calm and responsive way and supported them to talk about the issues affecting them. Staff knew the patients very well and were passionate about patients' needs. 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 that staff took the time to listen to them when they had a problem.
  • Hot drinks and snacks were available on request 24 hours a day. Patients were able to personalise their bedrooms.
  • Staff told us who the most senior managers in the trust were and that they had visited the wards. Ward managers told us they felt well supported by their line managers.

However:

  • Staff did not always review risk assessments following incidents.
  • There was limited access to psychological therapies. The service had one whole time consultant psychologist and one whole time assistant psychologist for both community and inpatient older adult services.
  • Trust data showed supervision rates across the service between January 2017 and March 2017 to be 66%. The trust could not be assured that performance issues and training needs were identified or acted upon.
  • Capacity assessments were not decision specific, forms included more than one question.
  • One patient was receiving covert medication, we did not find a capacity assessment form for this.
  • There was little evidence of patient participation in care plans and risk assessments. Four patients reported that they had not seen or been provided with a copy of their care plan.
  • Patients had a lockable drawer in their bedroom; however keys were not available for patients to lock the drawer.

Community-based mental health services for older people

Good

Updated 9 June 2017

We rated community based community mental health services for older people as good because:

  • All patient information was stored electronically and was accessible to staff.

  • The service followed National Institute for Health and Care and Excellence (NICE) guidance in prescribing medication and reviewing patients who had dementia.

  • Patients were consistently positive about the centres and about the staff, patients felt understood and cared for.

  • Patients told us that they felt involved in their care planning and that they had been offered a copy of their care plan.

  • Staff were able to prioritise and see urgent referrals quickly.

  • There was a safeguarding champion available to support staff with safeguarding concerns and safeguarding posters were displayed in the reception areas at each of the locations.

  • Staff learned from incidents, complaints and patient feedback via the bi monthly lessons learned bulletin, at team meetings and during supervision. We saw examples of lessons learned and changes in practice as a result of this.

  • Leaflets were available in different languages and information was available in different formats on request.

  • Staff were passionate about their jobs and used the trusts’ vision and values in their everyday work.

  • Senior managers were visible and known to staff. They visited the locations to update staff on changes within the service and the trust.

  • Sickness and absence rates were low and clear strategies were in place to cover any staffing shortfalls.

Child and adolescent mental health wards

Good

Updated 9 June 2017

We rated

child and adolescent mental health wards as good because:

  • The ward was clean, tidy and well maintained. Observation mirrors and closed circuit television was used to assist nursing staff with observations.

  • The ward had an up to date ligature risk audit, staff mitigated the risk on the ward by observing patients. Staff mitigated the risks posed in the garden area by accompanying patients when they wanted to access the garden.

  • The ward had sufficient staff to provide good care and treatment to patients.

  • The ward met the criteria for eliminated mixed sex accommodation in line with guidance contained in the Mental Health Act code of practice.

  • Staff were 98% compliant for mandatory training.

  • Staff undertook a risk assessment with every patient upon admission. Care plans were comprehensive, personalised, holistic, and recovery orientated.

  • Staff provided a range of therapeutic interventions in line with the National Institute for Health and Care Excellence guidelines and there was a full education programme in place.

  • Staff read detained patients their rights on admission and regularly thereafter. Staff gave patients an information leaflet explaining their rights and responsibilities as an informal patient.

  • Overall, 100% of non-medical staff had an up to date appraisal.

  • There was a well-functioning multidisciplinary team. Staff discussed patients’ care and treatment weekly in ward round. Parents told us that they felt involved in the care and treatment.

  • Patients told us that they felt supported to make their own decisions and staff treated them with dignity and respect. Patients said they were involved in their care plan.

  • Staff interacted with patients in a positive way. All staff demonstrated a good understanding of patients’ individual needs, including care plans, observations and risks.

  • The ward had a range of rooms and equipment to support treatment and care. There was a large garden; with an area that had been made secure. Patients could personalise their bedrooms and could choose from a choice of bedding.

  • There was a family room for parents, carers and siblings to visit. Visits within the community and the garden area were also encouraged.

  • There was access to activity across the week with primarily nurse led sessions over the weekend. Patients worked with the activity coordinator to plan activities that they would like to do.

  • All staff demonstrated the trust values in their behaviour and attitude. Staff we spoke with were passionate about helping patients with mental illness. Staff were proud of the work that they carried out and the care that they provided to patients.

  • Managers told us they had sufficient authority to complete their role and they felt supported by senior managers.

However:

  • Staff kept most doors on the ward locked. There was no clinical justification for this practice and it was not individually care planned. This was a blanket restriction.

  • Seventy-one per cent of staff had undertaken training in clinical risk assessment and management. This was below the trust target of 95%.

Forensic inpatient or secure wards

Good

Updated 9 June 2017

We rated forensic inpatient/ secure units as good overall because:

  • Francis Willis was a slightly dated but pleasant environment. There were clear lines of sight throughout the ward. The trust has completed detailed ligature risk assessments and plans were in place to appropriately manage these risks within the unit.

  • The defibrillator and essential safety equipment had been serviced and regular checks were undertaken.

  • There was sufficient staffing during weekdays and the unit had medical support at all times. Staff had undertaken mandatory training and received regular supervision and appraisal

  • Nursing staff on the wards were enthusiastic in their approach and patients spoke positively about them. The clinical team contained full multi-disciplinary representation.

  • All admissions were planned following pre admission assessments. Local risk assessments were also carried out after admission. Patient care plans were personalised and based around the individualised risk.

  • All patients had their physical healthcare needs met and there was an effective health care recording system

  • Leadership on the unit was highly visible and managers had a positive presence on the ward.

  • Areas of concern highlighted following our previous inspection had been addressed.

    However:

  • We remain concerned about the safety of the garden area of the ward. This contained potential ligature points and additional safety risks that had not been addressed through environmental risk management plans. Staff managed these risks through restricting patient access.

  • We found some other examples of blanket restrictions. These included access to mobile phones and set vaping times.

  • While patients had a good level of activity and escorted leave during weekdays there were limited activities available at weekend.