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Provider: Lincolnshire Partnership NHS Foundation Trust Good

Reports


Inspection carried out on 16 October to 08 November 2018

During a routine inspection

  • The trust responded in an extremely positive way to the improvements we requested them to make following our inspection in April 2017. At this inspection, we saw significant improvements in the core services we inspected and an impressive ongoing improvement and sustainability of good quality care across the trust as a whole. The senior leadership team had been at the fore front of delivering quality improvement and there was a true sense of involvement from staff, patients and carers towards driving service improvement across all areas.
  • Leadership had been invested in at all levels so that staff had the right skills, behaviours, knowledge and experience to challenge as necessary and to ensure quality and sustainability of service delivery. This was underpinned by a very strong senior leadership team that had identified priorities, driven cultural change at a pace and led by example. The trust board and senior leadership team displayed integrity on an ongoing basis. The trust’s non-executive members of the board challenged appropriately and held the executive team to account to improve the performance of the trust. The trust leadership team had a comprehensive knowledge of current priorities and challenges and took action to address them. The board were supportive to the wider health and social care system, with both the chair, chief executive and executive team taking up key roles in the local system including through Sustainability Transformation Programme. Reports from external sources, that include NHS Improvement and commissioners, was consistently favourable.
  • The trust had a clear vision and set of values with quality and sustainability as the top priorities which were robust and realistic. These had been co-produced with staff at all levels and patients. Values were fully embedded throughout the trust through recruitment, new initiatives, staff appraisals and staff wellbeing. At board and committee meetings discussions were consistently linked to the values. We were particularly impressed that each service had identified specific behaviours that aligned with each value so they had close alignment with their services. Each individual team across the trust had taken time to ensure that they understood what the values and behaviours meant for their individual teams and the patients that they provided care for. Local leadership across the trust was strong, visible and effective. Staff were particularly praising of the chief executive and the chair of the trust.
  • We found that there has been a continued and impressive cultural shift to an organisation that is truly inclusive, that enabled and empowered staff and patients to be heard and became part of the culture of change. The culture had truly been embedded and promoted an arena across the trust for shared learning and encouragement of staff to offer ideas to improve service delivery and patient experience. Staff showed pride and spoke passionately about their roles and working for the trust, their personal progression, opportunities to access specialist training and open and transparent relationships with senior colleagues.
  • The building of a continuous quality improvement and innovation culture has enabled the trust to move from a top down organisation to a system where staff were empowered to make decisions for improvement for the benefit of services to patients. The delivery of innovative and continuous quality improvement was central to all aspects of the running of the service. There was a true sense of desire to drive service improvement for the benefit of patients, carers, and the wider system, evident throughout the inspection. Staff included patients in service improvement and used their feedback to change practice. The trust actively sought to participate in national improvement and innovation projects, and encouraged all staff to take ownership, put forward ideas and remain involved throughout the process. The trust had improved their focus and the attention that they paid to innovation in the last 2 years which had yielded positive outcomes and national awards. Research was acknowledged as an asset in the trust. For the first time in 2018 the research annual report and outcomes was published highlighting the excellent work done across the organisation. The trust was proud to highlight the research and innovation conference which was attended by nearly 100 attendees. The conference encouraged staff to take their first step on research and understand what research can mean for them.
  • Engagement with both staff and patients was evident and was seen to be fundamental to the way that the trust makes decisions, changes and manages the services. Peer support workers, experts by experience and clinical apprentices were not only valued in teams but part of them and strengthen the voice and the participation of the patients. The trust had invested in these patients and provided training and mentorship to them. Staff, patients and carers were actively involved in a number of different ways and the trust prioritised engagement at every level and through all services. Patients, families and carers were encouraged to provide feedback on the care they had received by a number of routes, for example, via focus groups, questionnaires and a variety of engagement events.
  • Staff across all services spoke highly of the executive team and chair without exception. We observed that the vision and values of the organisation were truly embedded throughout the trust and reflected in all aspects of care delivery; including service re design. The commitment to equality and diversity was exemplary. The equality strategy had been produced to clarify the intentions and obligations of the trust and to openly show their commitment to equality and diversity. We were told about several examples of how the views of the members of the networks and individuals were fully integrated into defining the tone and philosophy of the trust. Throughout the year the trust had held equality Conferences to raise awareness of equality areas, jointly with Lincolnshire NHS providers and internal staff networks. The trust was proud to share with us the progression of the multi-agency LGBT+ conference. Staff network groups provided a platform for staff to voice their opinions and support the trust to improve working practices and services.
  • Staff showed caring, compassionate attitudes, were proud to work for the trust, and were dedicated to their roles. We were impressed by the way all staff in the trust embraced and modelled the values. The values were embedded in the services we visited, and staff showed the values in their day-to-day work. Throughout the trust, staff treated patients and each other with kindness, dignity and respect. The style and nature of communication was kind, respectful and compassionate and met the needs of the individual patients. Staff showed strong therapeutic alliances with their patients and carers and clearly understood their needs and wishes. Staff offered guidance and caring reassurance in all therapeutic interventions, but they were in particularly inspiring and skilled when they supported patients that felt unwell or distressed, confused or agitated. Overall, positive feedback was received from those patients, families and carers spoken with about the care and treatment received from staff. Patients told us that they felt safe across the trust. The trust promoted a person-centred culture and staff involved patients and those close to them as partners in their care and treatment. Staff provided positive emotional support to patients.
  • The trust had robust systems and processes for managing patient safety. Staff recognised when incidents occurred and reported them appropriately. The board had oversight of incidents, and themes and trends were identified and acted upon. Managers investigated incidents appropriately and shared lessons learned with staff in a number of ways. When things went wrong, staff apologised and gave patients honest information and suitable support. The trust applied the duty of candour appropriately. We reviewed serious incident reports and found investigations were thorough and included participation from family and carers; where appropriate. Staff had training on how to recognise and report abuse and applied it. The trust had effective systems for identifying risks and planning to eliminate or reduce them. We were particularly impressed with the trust focus on reducing dormitories style accommodation in the inpatient services. The trust was committed to improving services by learning from when things go well and when they went wrong.
  • The management of risk and the use of data has significantly improved since our last inspection. Data was being turned into useful information for all levels of staff to use to inform practices. We were impressed with the trust decisive and swift move from a RAG rating system of reporting to a statistical process control technique. In addition, this they had also implemented NHS Improvement summary icons to indicate the type of variation seen on each reporting indicator. This proactive and positive change has enabled the board to focus on changes in performance which merit discussion and potential interventions required.
  • The board had listened to staffs’ feedback about the patients’ electronic record and invested in replacing the system. The new system went live in September 2018. The new system supported staff to maintain clear records of patients’ care and treatment and ensured patient confidentiality was maintained. Staff we spoke with were pleased with the new system and felt the trust had delivered quality training to support them to use it. Whilst they acknowledged that it was still early days using the system they had all noted that the system was a vast improvement and supported them in their day to day work. Care and treatment records were clear, up-to-date and available to all staff providing care. The trust provided care and treatment based on national guidance. Patients had access to psychological support and occupational therapy. The physical healthcare needs of all patients were met. Patients that were admitted to acute hospitals were supported by mental health and learning disability practitioners during their admission and throughout the discharge process.
  • Staff were compliant with mandatory training across all services and staff had opportunities for further training to support care and treatment for patients. Managers ensured staff received supervision and yearly appraisals.
  • The trust ensured safe staffing levels were maintained. Staffing levels and skill mix across all core services was planned and reviewed so that people who used services received safe care and treatment. Managers ensured services across the trust increased staffing based on clinical need or made arrangements to cover leave, sickness and absence.
  • Trust premises across all mental health and community teams were clean and well maintained. Across services staff had completed environmental risk assessments. Where issues had been identified, staff mitigated these risks by carrying out additional checks or had taken other actions to resolve the issues. The trust had robust estate management processes and ongoing plans for improvements.
  • The trust had a clear oversight and had promoted the importance of wellbeing amongst their workforce. The wellbeing service demonstrated the responsiveness of the organisation to support the wellbeing of staff. The service had a dedicated psychological and occupational therapy service which included a dedicated counsellor for staff experiencing domestic abuse. Staff we spoke with throughout the inspection spoke highly of the wellbeing service and acknowledged that the trust had worked hard to deliver a service that met the diverse needs of the staff that worked across the trust.
  • We were pleased that the trust had reviewed the appropriateness of the governance arrangements in relation to the Mental Health Act administration and compliance. They had recognised that this was a key area to strengthen to ensure the best possible outcomes for patients detained under the Mental Health Act. This review led to the implementation of a policy document and flowchart being devised and implemented in both clinical division and corporate teams to highlight the correct procedure for the administration of the Act. Heat maps were produced to identify to teams the proactive reading of patients’ rights, reviews of sections and the completeness of the detention paperwork. Audits for Mental Health Act and Community Treatment Orders were clearly documented.
  • Systems for the safe management and administration of medicine were in place. Incidents and errors within the trust were reported and investigated and outcomes and learning shared with staff. The pharmacy team were now involved in the reviewing of serious incidents when medicines were involved.

However:

  • The trust continued to have difficulties in recruiting substantive consultant and medical staff. It remained above the budget of medical agency expenditure to cover consultant vacancies.
  • The recording of staff supervision remained an issue. Whilst we recognise that, since the last inspection, the trust had taken action in order to promote staffs experience and compliance with supervision, the recording systems were not robust and did not capture staffs’ compliance with supervision. However, we note the compliance figures were on an upward trajectory and were confident that this would continue to increase.
  • In the near future they were going to be some very significant changes in the senior leadership team in the upcoming months. Whilst we acknowledge how this is being thought through, planned and managed over time, we have some concern that this could potentially be de-stabilising.


CQC inspections of services

Service reports published 16 January 2019
Inspection carried out on 16 October to 08 November 2018 During an inspection of Acute wards for adults of working age and psychiatric intensive care units Download report PDF | 467.74 KB (opens in a new tab)Download report PDF | 1.41 MB (opens in a new tab)
Inspection carried out on 16 October to 08 November 2018 During an inspection of Community-based mental health services for adults of working age Download report PDF | 467.74 KB (opens in a new tab)Download report PDF | 1.41 MB (opens in a new tab)
Inspection carried out on 16 October to 08 November 2018 During an inspection of Community mental health services with learning disabilities or autism Download report PDF | 467.74 KB (opens in a new tab)Download report PDF | 1.41 MB (opens in a new tab)
See more service reports published 16 January 2019
Service reports published 9 June 2017
Inspection carried out on 03 to 07 April 2017 and 20 April 2017 During an inspection of Child and adolescent mental health wards Download report PDF | 199.52 KB (opens in a new tab)
Inspection carried out on 03 to 07 April 2017 During an inspection of Acute wards for adults of working age and psychiatric intensive care units Download report PDF | 221.33 KB (opens in a new tab)
Inspection carried out on 03 to 07 April 2017 During an inspection of Community mental health services with learning disabilities or autism Download report PDF | 208.88 KB (opens in a new tab)
Inspection carried out on 03 to 07 April 2017 During an inspection of Specialist community mental health services for children and young people Download report PDF | 206.69 KB (opens in a new tab)
Inspection carried out on 3rd – 7th April 2017 During an inspection of Community-based mental health services for adults of working age Download report PDF | 188.31 KB (opens in a new tab)
Inspection carried out on 3-7 April 2017 and 20 April 2017 During an inspection of Forensic inpatient or secure wards Download report PDF | 197.3 KB (opens in a new tab)
Inspection carried out on 3 to 7 April 2017 During an inspection of Community-based mental health services for older people Download report PDF | 191.49 KB (opens in a new tab)
Inspection carried out on To Be Confirmed During an inspection of Wards for older people with mental health problems Download report PDF | 193.84 KB (opens in a new tab)
Inspection carried out on 3-7 April 2017 During an inspection of Long stay or rehabilitation mental health wards for working age adults Download report PDF | 212.63 KB (opens in a new tab)
Inspection carried out on 03 to 07 April 2017 During an inspection of Mental health crisis services and health-based places of safety Download report PDF | 243.03 KB (opens in a new tab)
See more service reports published 9 June 2017
Service reports published 21 April 2016
Inspection carried out on 30 November– 4 December 2015 During an inspection of Long stay or rehabilitation mental health wards for working age adults Download report PDF | 289.66 KB (opens in a new tab)Download report PDF | 292.03 KB (opens in a new tab)
Inspection carried out on 30 November - 4 December 2015 During an inspection of Forensic inpatient or secure wards Download report PDF | 264.61 KB (opens in a new tab)Download report PDF | 292.03 KB (opens in a new tab)
Inspection carried out on 1 December 2015 During an inspection of Child and adolescent mental health wards Download report PDF | 316.02 KB (opens in a new tab)Download report PDF | 292.03 KB (opens in a new tab)
Inspection carried out on 30 November – 4 December 2015 During an inspection of Specialist community mental health services for children and young people Download report PDF | 313.6 KB (opens in a new tab)Download report PDF | 292.03 KB (opens in a new tab)
Inspection carried out on 30 November - 4 December 2015 During an inspection of Community mental health services with learning disabilities or autism Download report PDF | 298.01 KB (opens in a new tab)Download report PDF | 292.03 KB (opens in a new tab)
Inspection carried out on 30 November to 4 December 2015 During an inspection of Community-based mental health services for older people Download report PDF | 303.08 KB (opens in a new tab)Download report PDF | 292.03 KB (opens in a new tab)
Inspection carried out on 1 to 3 December 2015 During an inspection of Community-based mental health services for adults of working age Download report PDF | 321.43 KB (opens in a new tab)Download report PDF | 292.03 KB (opens in a new tab)
Inspection carried out on 30 November to 4 December 2015 During an inspection of Wards for older people with mental health problems Download report PDF | 314.24 KB (opens in a new tab)Download report PDF | 292.03 KB (opens in a new tab)
Inspection carried out on 01 – 03 December 2015 During an inspection of Acute wards for adults of working age and psychiatric intensive care units Download report PDF | 340.44 KB (opens in a new tab)Download report PDF | 292.03 KB (opens in a new tab)
See more service reports published 21 April 2016
Service reports published 27 March 2015
Inspection carried out on 26 November 2014 During an inspection of Forensic inpatient or secure wards Download report PDF | 260.27 KB (opens in a new tab)
Inspection carried out on 26 November 2014 During an inspection of Acute wards for adults of working age and psychiatric intensive care units Download report PDF | 262.93 KB (opens in a new tab)
Inspection carried out on 3 – 7 April 2017 and 20 April 2017

During a routine inspection

When aggregating ratings, our inspection teams follow a set of principles to ensure consistent decisions. The principles will normally apply but will be balanced by inspection teams using their discretion and professional judgement in the light of all of the available evidence.

We rated the trust overall as good because:

  • The trust had responded in a positive way to the improvements we asked them to make following their last inspection. Improvements in most core services were noted across the trust.

  • Patient care environments were clean, in good decorative order and appropriately furnished. Services had sufficient rooms for the safe care and treatment of patients, including private areas for patients to receive 1-1 support from staff or see visitors. All inpatient services had activities programmes for patients. There was access to activities over a seven day period. Each ward had timetables visible so that patients knew what was on offer. Patients could personalise their bedrooms and had lockable storage for their possessions. The trust was meeting Department of Health guidance for eliminating mixed sex accommodation.

  • The trust had made significant improvements to the external courtyards on the adult acute wards since our last inspection. For example, installation of closed circuit television and two way intercom systems and removal of ligature risks. Works were still on-going. In the inpatient ward for children and young people, innovative observation panels were fitted on bedroom doors, which had privacy frosting on them that was removed electronically when staff pressed a button.

  • The trust was opening a psychiatric intensive care unit for males in the summer of 2017 and had plans to provide a psychiatric high dependency unit provision for females.

  • The trust had reviewed its management of ligature risks within services. Staff were aware of the risks in their environments and ligature assessments were re-assessed regularly. On inpatient wards, staff had quick access to ‘heat maps’, specific to their area, to assist in the safe management of patients presenting with high risk of self harm or suicide.

  • Throughout the trust, staff treated patients with kindness, dignity and respect. Consistently, staff attitudes were helpful and understanding. Staff used kind and supportive language that patients would understand. Staff encouraged patients to give feedback about their care in a variety of ways. Information leaflets were available in easy read formats and we saw evidence of a variety of information available to patients, for example on how to access interpreters, make complaints, access to advocacy and Mental Health Act information.

  • The trust employed suitably qualified and experienced staff to deliver safe care and treatment to patients and provided them with training and development opportunities. The trust had supported healthcare support workers to undertake training to become registered nurses, provided a robust induction programme and supported clinical apprenticeship to encourage young people to seek employment with the organisation. The trust utilised a values based recruitment checklist during their interview process and revisited this during staff induction. The trust also operated a rewards and recognition system, including individual and team recognition, thank you cards, hero’s awards and annual awards ceremonies.

  • Managers ensured staffing levels across all core services were planned and regularly reviewed. The majority of services across the trust increased staffing based on clinical need and made arrangements to cover leave, sickness and absence. Local managers had authority to make these decisions. The trust employed bank or agency staff to fill vacancies. Where possible, managers ensured temporary staff were familiar with the patients and teams in which they worked. This ensured continuity of care for patients. Bank staff received appropriate training for their roles.

  • Staff received mandatory and role specific training. As at 31 March 2017, the overall compliance across all core services was 92%. Staff had access to additional specialist training, relevant to their role and medical staff had protected time for training and development.

  • Staff received an annual appraisal. As at 31 March 2017, 92% staff were compliant.

  • The trust reported a reduction in staff sickness rates. In December 2015, staff sickness was reported as 5.1%. In February 2017, this had reduced to 4.5% as a 12-month average.

  • The trust regularly reviewed caseloads for staff working in community teams. Where caseloads were high, staff were able to explain the rationale for this.

  • Crisis teams were meeting commissioned targets for contacting patients within four hours. As of February 2017, 99% of patients were contacted within this time. Crisis teams had good working relationships with the local Police

  • The trust had a robust governance structure in place to manage, review and give feedback from complaints. Staff consistently knew how to handle complaints, and managers investigated complaints promptly Patients and carers received timely responses and outcomes.

  • The trust had safeguarding policies and robust safeguarding reporting systems in place and described how they worked with partner agencies to protect vulnerable adults and children.

  • The trust used an electronic system for reporting incidents. Trust staff knew what incidents needed to be reported and how to report them. Managers monitored the reporting and recording of incidents. The trust had robust systems for sharing lessons learned from incidents. We saw evidence of compliance with duty of candour guidance related to investigations from serious incidents and complaints. Patients, families and carers were fully involved and informed throughout all processes. The trust board encouraged candour, openness and honesty from staff. Staff knew how to whistle-blow and staff felt able to raise concerns without fear of victimisation.

  • The trust had robust process to monitor the fitness of senior staff to work within the service, under the principles of fit and proper persons requirements.

  • Senior managers told us there had been much organisational change and transformation of care within the trust. Staff told us they accepted change and positively embraced the opportunity it provided. They felt supported by the board to work with change and felt able to provide feedback about their experiences. Overall, we found significant improvement to staff morale across most teams.

  • The trust had robust systems in place to manage the prescribing, storage and administration of medication. We found good working practices between the pharmacy team and staff across all services.

  • Overall, we saw good multidisciplinary working and generally patients’ needs, including physical health needs, were assessed and care and treatment was planned to meet them.

  • Staff had a process in place to submit concerns and issues to the local risk registers which fed in to the trust wide risk register where appropriate.

However:

  • Whilst there had been significant progress since the last inspection in 2015, the trust had not fully addressed all our previous concerns.

  • The trust could not always provide a bed locally for patients who required admission to adult acute mental health beds. This meant that patients often received care and treatment outside of the trust. Between March 2016 and March 2017, there were 306 out of area placements from the trust to other providers of acute adult inpatient care. The trust did not have psychiatric intensive care unit (PICU) beds. Therefore, if a PICU bed was required, patients were placed out of area. Between February 2016 and February 2017, 63 patients were transferred to other providers when intensive care was required.

  • Bed occupancy rates were above 100% on the adult acute wards. We saw that patient numbers exceeded the number of beds available on wards. Therefore, there were no beds available if patients returned from leave.

  • The majority of beds within the adult acute admission wards were located in bays sleeping either four or five patients. These areas offered limited space and privacy.

  • Within the forensic inpatient secure ward we found patients did not have free access to the garden. This was a blanket restriction. We were also concerned about the safety of the security fencing in the garden area. We raised this with the trust who made immediate plans to have this replaced.

  • In the inpatient ward for children and young people, most doors on the ward were locked, this included bedrooms, toilets and bathrooms, dining room, the female only lounge and doors to the garden. There was no clinical justification for this practice and it was not individually care planned. This was a blanket restriction. We raised these concerns with senior managers and when we returned on 20 April, the trust had taken action to ensure patients were provided with wrist bands, programmed to allow access to specified areas.

  • The trust had identified they need to take further actions to ensure the health based place of safety fully met the Royal College of Psychiatrist standards.

  • Not all patients had timely access to psychological therapies as recommended by the National Institute for Health and Care Excellence.

  • Information from April 2016 to March 2017 showed 242 patients were discharged from the health based place of safety within 72 hours. On 127 occasions, staff had not completed the patient’s discharge time on records.

  • The trust provided data for staff compliance with clinical supervision; however, this showed significant variance in compliance across teams. The trust told us they had introduced a new method of recording supervision, which was not yet fully embedded. Clinical and managerial supervision data was not collected separately. However, data provided showed overall compliance with clinical supervision across all core services ranged from 7% in October 2016 to 88% in March 2017, with an overall average compliance across all core services of 48%, against the trust target of 95%. From data provided and on site findings, we were unable to determine how supervision was delivered, for example how often staff received one to one support, or whether managerial supervision was provided in accordance with the trust policy. It was equally unclear how outcomes from staff supervision were reviewed or acted upon. We were not, therefore, assured the trust had clear oversight of compliance with management supervision. The trust could not be sure that all performance issues, training requirements or professional development had been identified for staff working in the service.

  • Not all staff had completed mandatory training in line with the trust target. For example, on the acute wards for adults only 58% of staff had completed safeguarding children level 3 training. We were concerned that only 63% of staff were compliant with basic life support training, meaning they might not have the required or up to date skills to support patients in an emergency. Equally, only 61% had completed conflict resolution (restraint) training, meaning they might not have the required or up to date skills to safely manage patients requiring physical interventions.

  • The trust policy on the management of violence and aggression did not contain guidance from the Mental Capacity Act relating to the use of prone restraint and did not reference up to date National Institute for Health and Care Excellence guidelines. We found an increase since our last inspection in both incidents of restraint and the use of prone (face down) restraint.

  • We found some errors on community treatment order paperwork. Seclusion paperwork did not always meet the guidance in the Mental Health Act Code of Practice and medical assessments were not always fully completed or recorded. Staff did not complete seclusion care plans for patients nursed in seclusion on the adult acute wards.

Inspection carried out on 30 November- 4 December 2015

During a routine inspection

When aggregating ratings, our inspection teams follow a set of principles to ensure consistent decisions. The principles will normally apply but will be balanced by inspection teams using their discretion and professional judgement in the light of all of the available evidence.

We rated Lincolnshire Partnership NHS Foundation Trust as Requires Improvement overall because:

  • Not all services were safe or effective and the board needs to take action to address areas of improvement.
  • Some of the wards did not provide an environment that was safe or that preserved patients’ dignity or privacy. The layout of some wards and ward garden areas meant that staff could not easily observe patients who might be at risk. We were concerned about the design of the place of safety and seclusion facilities at some units. Some wards had fixtures and fittings that people at risk of suicide could use as a ligature anchor point; the trust had not addressed these risks adequately. Not all wards met the requirements of single sex accommodation guidance or the Mental Health Act (MHA) code of practice. Some seclusion rooms and dormitory areas did not promote privacy and dignity.
  • Restrictive practices that amounted to seclusion were not reported or safeguarded appropriately.
  • Staff on the acute, forensic and child and adolescent wards imposed blanket restrictions that were not based on an assessment of the risks of individual patients.
  • Some wards in the rehabilitation, forensic and children’s mental health services had too few staff on duty at times to keep patients safe and others relied heavily on the use of bank and agency staff.
  • Staff were not always receiving supervision in line with the trust policy.
  • We were concerned that information management systems did not always ensure the safe management of people’s risks and needs.
  • Access arrangements needed improvement. There was a lack of availability of acute beds. There were delays for assessment from community adult teams and there was limited access to psychological therapy.
  • While performance improvement tools and governance structures were in place these had not always brought about improvement to practices.
  • While the board and senior management had a vision with strategic objectives in place, morale was found to be poor in some areas, particularly community teams, and some staff told us that they did not feel engaged by the trust.

However:

  • Staff showed us that they wanted to provide high quality care, despite the challenges of staffing levels and some poor ward environments. We observed some very positive examples of staff providing emotional support to people.
  • Services were clean with good infection control practices.
  • There had been significant work on reducing restrictive intervention.
  • Procedures for incident management and safeguarding where in place and well used. The trust was meetings its obligations under Duty of Candour regulations.
  • The trust had participated in a range of patient outcome audits, research and accreditation schemes.
  • The trust had an involvement policy which set out the trust’s commitment to working in partnership with service users. The trust told us about a number of initiatives to engage more effectively with users and carers.
  • Complaint information was available for patients and staff had a good knowledge of the complaints process.
  • Overall we saw good multidisciplinary working and generally people’s needs, including physical health needs, were assessed and care and treatment was planned to meet them.

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.


Archived core service reports

These reports are for core services no longer offered by this provider. They are available here for reference so you can find out about the history of the reports and ratings.


Joint inspection reports with Ofsted

We carry out joint inspections with Ofsted. As part of each inspection, we look at the way health services provide care and treatment to people.


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.