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Provider: Midlands Partnership NHS Foundation Trust Good

Inspection Summary


Overall summary & rating

Good

Updated 5 July 2019

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

  • We rated safe, caring, responsive and well-led as good. We rated effective as requires improvement. Our rating for the trust took into account the previous ratings of services not inspected this time. In this case that included the historic South Staffordshire and Shropshire Healthcare NHS Foundation Trust mental health services.
  • Our decisions on the overall ratings consider factors including the relative size of services and we used our professional judgement to reach a fair and balanced rating.
  • We rated well-led at the trust level as good. The trust had a strong and experienced leadership team, supported by efficient reporting and governance structures. Non-executive directors and the council of governors were very active in providing independent oversight of the executive team.
  • Managers had successfully managed the merger of community services into the trust in June 2018. Integration of physical health and mental health services was having a positive impact on patient care. However, some services still required support to be fully integrated into the systems and culture of the trust. This was recognised in a post-merger action plan.
  • Overall, clinical services were safe and effectively safeguarded patients from harm. Risk assessments were completed and update regularly within most services visited.
  • In most areas care planning was personalised and holistic reflecting input from the patient or their carers. There was effective multi-disciplinary team working across the trust both within and between individual care teams.
  • Physical health care needs were effectively addressed within the core mental health services.
  • Staff ensured the rights of patients detained under the Mental Health Act. The trust closely monitored its use of the act and fulfilled its obligation under the Code of Practice. There was good practice in the use of the Mental Capacity Act and staff offered support to patients to make their own decision where possible.
  • Staff were caring, and we heard overwhelmingly positive feedback about their professionalism and respect for the dignity and privacy of patients.
  • With few exceptions, access to services was responsive; there was effective bed management in the mental health wards and timely responses to mental health problems in the community.
  • The recovery college supported patients and staff with mental health problems overcome stigma and social exclusion. Led by current and ex mental health service users the college received very positive feedback about the skills and life lessons they had learned.

However:

  • Managers could not provide assurance around the safety of care in the urgent care services. We found that the urgent care services had not been effectively integrated into the otherwise robust governance systems we found within the trust. This left us with concerns about the reporting and recording of incidents within the service.
  • Staff left patients potentially at risk in the urgent care services. There was no triage system to determine the priority given to patients attending the two urgent care services. The time of clinical assessment of a patient had been determined by their time of arrival rather than need. The trust did promptly address this and institute a triage system within two working days.
  • Although on a recovery journey, there were still concerns about the responsiveness and capacity to meet patient’s needs within the Shropshire, Telford and Wrekin child and adolescent community mental health services.
  • Managers had not supported staff through regular clinical supervision in some areas. There was no central recording of supervision to allow care group managers to monitor this.
  • Staff had not dealt with complaints received by the community health services in a timely manner. Managers were making changes in the way complaints were investigated to address this.
  • Some clinical areas did not have the space or facilities to ensure confidentiality, good hand hygiene and lacked capacity to meet demand for appointments.
  • Staff did not always have access to accessible information for patients or communication aids to support care delivery.
Inspection areas

Safe

Good

Updated 5 July 2019

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

  • All clinical premises where patients received care were safe, clean, well equipped, well furnished, well maintained and fit for purpose. All wards were safe, clean well equipped, well furnished, well maintained and fit for purpose. In mental health wards, staff could clearly see all areas of the ward and knew about any ligature anchor points and actions to mitigate risks to patients who might try to harm themselves.
  • The trust had enough staff, who knew the patients and received basic training to keep them safe from avoidable harm. The number of patients on the caseload of the teams, and of individual members of staff, was not too high to prevent staff from giving each patient the time they needed.
  • The trust provided mandatory training in key skills to all staff and made sure everyone completed it.
  • Staff assessed and managed risks to patients and themselves well and followed best practice in anticipating, de-escalating and managing challenging behaviour. We found very good practice throughout the trust in the care of people with dementia who presented with behaviours that challenge.
  • Staff assessed and managed risks to patients and themselves. They responded promptly to a sudden deterioration in a patient’s health. When necessary, staff working in the mental health crisis teams worked with patients and their families and carers to develop crisis plans. Staff followed good personal safety protocols.
  • Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Most staff had the required training on how to recognise and report abuse, and they knew how to apply it.
  • Staff had easy access to clinical information at trust bases and it was easy for them to maintain high quality clinical records – whether paper-based or electronic. The trust was attempting to improve access for community workers who worked remotely.
  • The trust had a good track record on safety.
  • The trust managed patient safety incidents well. Staff recognised incidents and reported them appropriately. A centralised investigation team investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support.

However:

  • There was no triage system in place at either of the two urgent care services inspected. This meant patients were not risk assessed on arrival and prioritised by need to receive clinical input. The trust responded quickly to the concerns we raised, and a triage system was put in place within two working days.
  • Within the urgent care service, we found no evidence that safeguarding alerts and incidents were being reported appropriately. There had been no safeguarding alerts and very few incidents reported. Problems with staffing and issues around safe care had not been fully investigated and lessons learnt to improve services.
  • Some emergency medicines and equipment were found to be out of date, unavailable or not fit for use in some dental settings. The problems were rectified on the day and we were assured that alternative equipment and in date medicines would have been available if required.
  • In Shropshire community child and adolescent mental health services and within some of the Staffordshire children’s community services staff did not always complete and update robust risk assessments for each young person and use these to understand and manage risks. Although the teams discussed areas of risk during meetings, staff did not consistently document young people’s most recent presentation of risk in their risk assessments. Not all risk assessments were updated regularly.

Effective

Requires improvement

Updated 5 July 2019

Our rating of effective went down. We rated it as requires improvement because:

  • Managers had failed to support some staff through regular supervision in line with the trust policy. This was the case in four of the core services we visited. This left staff without the regular support supervision offers and no way to progress and review development plans. It meant managers were unable to demonstrate how they had managed the impact of incidents and discussed lessons learnt with individual staff members.
  • There was no central recording of the managerial supervision of staff. Local records in some mental health care services demonstrated that supervision was not recorded in line with trust policy.

However:

  • Overall, staff assessed the physical and mental health of all patients. They developed individual care plans, reviewed them regularly through multidisciplinary discussion, and updated them as needed. Care plans reflected patients’ assessed needs, and were personalised, holistic and recovery-oriented.
  • 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. In community health services mental health concerns were recognised and escalated appropriately.
  • Staff used recognised rating scales to assess and record severity and outcomes. They also participated in clinical audit, benchmarking and quality improvement initiatives. There were over 100 improvement initiatives underway at the time of our inspection.
  • Clinical teams included or had access to the full range of specialists required to meet the needs of patients on the wards. The merger had bought community health services (physical and mental health) into one common organisation which had allowed better integration of care.
  • Staff from different disciplines worked together as a team to benefit patients. They supported each other to make sure patients had no gaps in their care. Ward and community teams had effective working relationships with other relevant teams within the organisation and with relevant services outside the organisation.
  • Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice and discharged these well. Managers made sure that staff could explain patients’ rights to them. The trust had robust procedures for the recruitment and management of the Hospital Managers. The trust was responsive to the findings of the Mental Health Act Reviewer reports.
  • Staff supported patients to make decisions on their care for themselves. They understood the trust policy on the Mental Capacity Act 2005 and assessed and recorded capacity clearly for patients who might have impaired mental capacity.

Caring

Good

Updated 5 July 2019

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

  • Staff treated patients with compassion and kindness. They respected patients’ privacy and dignity. They understood the individual needs of patients and supported patients to understand and manage their care, treatment or condition.
  • Staff involved patients in care planning and risk assessment and actively sought their feedback on the quality of care provided. They ensured that patients had easy access to independent advocates.
  • The trust had an active programme for the involvement of patients and carers in service development and evaluation of service effectiveness.
  • Staff informed and involved families and carers appropriately.
  • The crisis and home treatment team anticipated people's needs by offering a dedicated telephone number to patients for use post discharge if they required extra care and support from their key worker team.
  • Staff at Oak Ward care planned access to empathy dolls for patients who would benefit from them.
  • Baswich Ward was developing an end of life suite for patients and their carers. This suite would support people and those close to them by enabling patients requiring end of life care to have their family with them.
  • The learning disability or autism service had a deep understanding of the needs of the patient group and demonstrated a high level of person-centred care and interaction with patients. There was excellent engagement with carers and their input into care planning was clearly evident. Care plans were very detailed and there was an individual care plan for each identified need.

Responsive

Good

Updated 5 July 2019

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

  • In inpatient areas, staff managed beds well. A bed was available when needed and patients were not moved between wards unless this was for their benefit. Discharge was rarely delayed for other than clinical reasons.
  • Services were easy to access. The trust’s referral criteria did not exclude patients who would have benefitted from care. Staff assessed and treated patients who required urgent care for mental health problems promptly and patients who did not require urgent care did not wait too long to start treatment. Staff followed up patients who missed appointments.
  • The mental health crisis service was available 24-hours a day and was easy to access – including through a dedicated crisis telephone line. The crisis and home treatment team in Stafford offered a dedicated telephone number to patients for use within seven days of discharge. The referral criteria for the mental health crisis teams did not exclude patients who would have benefitted from care. Staff assessed and treated people promptly. Staff followed up people who missed appointments.
  • The health-based places of safety were available when needed and there was an effective local arrangement for young people who were detained under Section 136 of the Mental Health Act. Section 12 approved doctors and approved mental health professionals attended promptly when required.
  • The design, layout, and furnishings of the ward supported patients’ treatment, privacy and dignity. Each patient had their own bedroom with an ensuite bathroom and could keep their personal belongings safe. There were quiet areas for privacy.
  • Staff supported patients with activities outside the service, such as work, education and family relationships. The recovery college for people with long-term mental health problems focussed on life skills was led by current and ex-service users.
  • The service met the needs of most patients including those with a protected characteristic. Staff helped patients with advocacy and cultural and spiritual support.
  • The service treated concerns and complaints seriously, investigated them, learned lessons from the results, and shared these with the whole team and wider service.

However:

  • Although we saw improvement in the way the trust was monitoring children and young people on the waiting lists, the waiting lists in neurodevelopmental pathway remained high and no staff appointed within the Attention Deficit Hyperactivity Disorder pathway, which meant that children and young people were not receiving care in a timely manner.
  • In community health services, responsiveness to complaints was not timely and we saw no evidence that historic trust targets of 35 days had been met.
  • Not all services met accessible information standards. People with communication issues did not have their individual needs met at the units. The service did not always have communication tools for people with disabilities.
  • Some clinical areas within the community children’s service did not have the space or facilities to ensure confidentiality, good hand hygiene and lacked capacity to meet demand for appointments.

Well-led

Good

Updated 5 July 2019

Our rating of well-led stayed the same. We rated it as good because:

  • Managers at all levels in the trust had the right skills and abilities to run a service providing high-quality sustainable care.
  • Leaders had the skills, knowledge and experience to perform their roles. They had a good understanding of the services they managed and were visible in the service and approachable for patients and staff.
  • The trust had a vision of what it wanted to achieve and workable plans to turn it into action. Managers had developed the vision with involvement from staff, patients, and key groups representing the local community.
  • Staff knew and understood the trust’s vision and values and applied them to the work of their team. Staff within community health services were not as aware but those that were embraced the new organisation’s vision and values.
  • Managers across the trust promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values. The senior leadership team modelled those values and behaviours and had high visibility throughout the organisation.
  • Staff felt respected, supported and valued. They said the trust promoted equality and diversity in daily work and provided opportunities for development and career progression. They could raise any concerns without fear.
  • The trust used a systematic approach to continually improve the quality of its services and safeguarding high standards of care by creating an environment in which excellence in clinical care would flourish. Over 1000 members of staff had received training in quality improvement methods.
  • Our findings from the other key questions demonstrated that governance processes operated effectively at team level and that performance and risk were managed well overall.
  • The trust had effective systems for identifying risks, planning to eliminate or reduce them, and coping with both the expected and unexpected. We saw the trust responded effectively to a fire at one of their hospitals to secure the immediate safety of patients and staff. Managers had been able to put in place alternative accommodation within 48 hours of the incident.
  • Teams had access to the information they needed to provide safe and effective care and used that information to good effect. The trust had a plan for a unified patient record across community and mental health services by the end of 2019.

  • The trust collected, analysed, managed and used information well to support all its activities, using secure systems with security safeguards. Staff used data about outcomes and performance and engaged actively in local and national quality improvement activities.

  • Managers engaged actively with other local health and social care providers to ensure that an integrated health and care system was commissioned and provided to meet the needs of the local population. Managers from the service participated actively in the work of the local transforming care partnership.
  • There were effective, multi-agency arrangements to agree and monitor the governance of the mental health crisis service and the health-based places of safety. Managers of the service worked actively with partner agencies (including the police, ambulance service, primary care and local acute medical services) to ensure that people in the area received help when they experienced a mental health crisis; regardless of the setting.

However:

  • Managers could not provide assurance around the safety of care in the urgent care services. We found that the service had not been effectively integrated into the otherwise robust governance systems we found within the trust. This left us with concerns about the reporting and recording of incidents within the service.
  • Although on a recovery pathway, there were still concerns about the responsiveness and capacity to meet patient’s needs within the Shropshire, Telford and Wrekin child and adolescent community mental health services. As highlighted by NHS Improvement managers did not always have the information available to effectively judge the performance of the service.
  • Managers had not supported all staff through regular clinical supervision in some areas. There was no central recording of supervision to allow care group managers to monitor this. The trust policy on supervision emphasised its importance to monitoring performance and well-being of individual staff members.
  • Staff had not dealt with complaints received by the community health services in a timely manner. Managers were making changes in the way complaints were investigated to address this.
  • Managers told us that the electronic staff record did not allow the accurate recording of training data. The trust also faced challenges in unifying the electronic patient record to encompass physical and mental health team records.
  • The role of the freedom to speak up guardian was not well known across all services. In some locations, information about this, the trust’s vision and values and some other central staff support services had not been updated since the merger.
Checks on specific services

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

Good

Updated 5 July 2019

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

  • We rated safe, caring, responsive and well-led as good. We rated effective as requirement improvement.
  • 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 developed holistic, recovery-oriented 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 about best practice. Staff engaged in clinical audit 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 on the wards. The ward staff worked well together as a multi-disciplinary 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 so that a bed was always available locally to a person who would benefit from admission and patients were discharged promptly once their condition warranted this.

  • The service was well led, and the governance processes ensured that ward procedures ran smoothly.

However:

  • Managers had failed to provide support for staff through regular supervision or record sessions in line with the local policy. This left staff without the benefits regular supervision offers and no way to evidence and review development plans between annual appraisals.

Community dental services

Good

Updated 5 July 2019

We rated it as good because:

  • We rated safe, effective, caring, responsive and well-led as good.
  • There were sufficient numbers of suitably qualified staff to provide safe treatment for patients. Staff were encouraged to compete mandatory training relevant to their roles. Mandatory training rates were good, and these were actively monitored by managers.
  • There was good use of skill mix within the service including that of dental hygiene therapists and dental nurses with extended duties. There was a proactive approach towards multidisciplinary working, these included the trust’s learning disability team with whom they had a good working relationship.
  • Premises were clean and hygienic and used dental instruments were decontaminated and sterilised in line with nationally recognised guidance.
  • There were systems in place to protect patients from abuse or neglect. The service had a good safety record and there were systems in place to reduce the likelihood of never events occurring.
  • Staff were aware of the importance of obtaining informed consent prior to treatment. They had a good awareness of their responsibilities under the Mental Capacity Act 2005 and the principals of Gillick competence.
  • Patients were treated with dignity and respect. Patients told us that staff were friendly, amazing, cheerful and fantastic. Staff took time to help patients who needed extra support such as those with learning disabilities, mental health problems and patients who suffer from dental phobia.
  • The service took into account patients’ needs. All clinics we visited were fully accessible for wheelchair users or those with limited mobility. Translation services were available for patients who did not have English as a first language.
  • The appointment system met patients’ needs and there were arrangements for patients requiring emergency treatment both in and outside normal working hours. Waiting times for initial assessment and treatment were generally good.
  • There was a clear vision and strategy for the service and there were plans in place of how to achieve these. Staff morale was generally good across the service. There were effective governance arrangements in place. Staff engaged with patients, other healthcare professionals and external stakeholders in order to continually improve the service.

However:

  • We found some out of date adrenaline in the emergency drug kit at one clinic. This had not been identified or disposed of by the process in place for checking the medical emergency drugs.
  • Glucagon was not stored in a temperature-controlled environment and the expiry dates had not been changed to reflect this.
  • At two clinics which we visited there were no size 4 oropharyngeal airways.
  • At one clinic we visited the aspirin was not of the dispersible form as described in nationally recognised guidance.
  • Medical emergency equipment and medicines were not taken on domiciliary visits. This had not been formally risk assessed.
  • Although the service received very few complaints they were not always dealt with in a timely manner.

Community health inpatient services

Good

Updated 5 July 2019

We rated the service as good because:

  • We rated safe, effective, caring, responsive and well-led as good.
  • The service provided safe care. The ward environments were safe and clean. The wards had enough nurses and doctors and provided training in key skills. Staff assessed and managed risk well and used control measure to prevent the spread of infection.
  • The service provided care and treatment based on national guidance and made sure staff were competent for their roles. Staff of different kinds worked together as a team to benefit patients. Staff understood how and when to assess whether a patient had the capacity to make decisions about their care. Staff always had access to up-to-date, accurate and comprehensive information on patients’ care and treatment
  • 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 planned and provided services in a way that met the needs of local people and people could access the service when they needed it. The service took account of patients’ individual needs and treated concerns and complaints seriously.
  • Managers at all levels in the service had the right skills and abilities and promoted a positive culture. The service had a vision for what it wanted to achieve and workable plans to turn it into action. The service had effective systems for identifying risks and managed information well to support all its activities. There was a strong sense of involvement in the service and pride in the hospital from staff.

Community health services for children, young people and families

Good

Updated 5 July 2019

We rated the service as good because:

  • The leadership team helped keep people safe from avoidable harm and provided the right care and treatment, by planning for enough nursing staff with the right qualifications, skills, training and experience.
  • Staff were provided with mandatory training in key skills. Compliance was good, and education, training and development was promoted, supported and embedded.
  • The team provided care and treatment based on national guidance and could evidence of its effectiveness. Managers monitored and checked practice to make sure staff followed guidance. Staff consulted and adhered to National Institute for Health and Care Excellence guidelines which meant patients received evidence-based care.
  • Staff of different disciplines worked together as a team to benefit patients. GP’s, nurses and other key professionals worked together to provide good care. Joint working and collaboration with external stakeholders were embedded in the work carried out to support patients and their families.
  • Staff consistently cared for patients with compassion. Feedback from patients confirmed that staff treated them well and with kindness. Staff provided emotional support to patients to minimise their distress.
  • Staff involved patients and those close to them in decisions about their care and treatment.
  • Staff took account of patients’ individual needs. Interpreters were available for patients who did not speak English. Patients, carers and staff could access specialist services, for example, mental health teams for support.
  • People could access the service in a timely manner. Staff responded to referrals to treatment promptly and in line with good practice.
  • Managers had the right skills and abilities to run a service providing sustainable care. Managers across the trust promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values.
  • The trust was committed to improving services by learning from when things went well and when they went wrong. They promoted learning and professional development.

However:

  • Staff did not always use control measures to prevent the spread of infection. For example, being appropriately bare below the elbow and removing painted nails.
  • Staff within a minority of teams did not always complete risk assessments for each patient. Records did not always contain complete risk information to ensure staff could access appropriate risk information at the right time.
  • The quality of documented patient records was variable. They were not always clear, up-to date and available to all staff providing care.

Mental health crisis services and health-based places of safety

Good

Updated 5 July 2019

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

  • The service provided safe care. Clinical premises where patients were seen were safe and clean and the physical environment of the health-based places of safety met the requirements of the Mental Health Act Code of Practice. The number of patients on the caseload of the mental health crisis teams, and of individual members of staff, was not too high. Staff assessed and managed risk well and followed good practice with respect to safeguarding.

  • Staff working for the mental health crisis teams developed holistic, recovery-oriented care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the patients and staff engaged in clinical audit to evaluate the quality of care they provided.

  • The mental health crisis teams included or had access to the full range of specialists required to meet the needs of the patients. Managers ensured that staff received training, supervision and appraisal. Staff worked well together as a multi-disciplinary team and with relevant services outside the organisation.

  • 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 and understood the individual needs of patients. They actively involved patients and families and carers in care decisions.

  • The mental health crisis service and the health-based places of safety were easy to access. Staff assessed people promptly. Those who required urgent care were taken onto the caseload of the crisis teams immediately. Staff and managers managed the caseloads of the mental health crisis teams well. The services did not exclude people who would have benefitted from care.

  • The services were well led, and the governance processes ensured that procedures relating to the work of the service ran smoothly.

Wards for older people with mental health problems

Good

Updated 5 July 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. 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 developed holistic, recovery-oriented or strengths based supportive 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 ward teams included the full range of specialists required to meet the needs of patients on the wards. Managers ensured that these staff received training, supervision and 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 so that a bed was always available locally to a person who would benefit from admission and patients were discharged promptly once their condition warranted this.

  • The service was well-led, and the governance processes ensured that ward procedures ran smoothly.

Specialist community mental health services for children and young people

Requires improvement

Updated 5 July 2019

Our rating of this service went down. We rated it as requires improvement overall.

We rated caring as good and safe, responsive, effective and well led as requires improvement because:

  • Across the core service there were inconsistencies in addressing issues from the previous inspection. There were differences in quality of practice between Shropshire and Staffordshire. We concluded that services in Staffordshire were of a good quality. Our concerns were about the services for the people of Shropshire.
  • In Shropshire there were concerns in the way the trust triaged referrals within the access team. At the time of the inspection despite the service having been commissioned, the trust had allocated no staff to assess people for attention deficit hyperactivity disorder (ADHD). This meant that the waiting list for pathways was high and waits were getting longer.
  • Not all risk assessments were updated regularly and care plans within Shropshire lacked detail and did not reflect the views of the children and young people or their families. Carers and young people told us they were not given copies of care plans.
  • Staff considered patients’ capacity to make decisions about their care but did not consistently or effectively record these considerations in the patient’ records within Shropshire.
  • Services in Shropshire made limited use of outcome measures. This reduced their ability to monitor patient progress. Not all staff were aware of or involved in clinical audits.
  • Staff morale in Shropshire was generally low and staff felt isolated from the other teams in the trust.
  • Local managers in Shropshire had not ensured thorough and robust oversight or audits around the quality of documentation within the clinical records.
  • Staff did not complete regular environmental risk assessments. Staff were not aware of where the environmental risks were.
  • Staff were not consistently checking calibration of clinical equipment and there was no system in place to monitor this.
  • Although we found that staff received regular supervision, the trust did not have a consistent and effective system for collating and monitoring supervision data.

However:

  • Staff regularly reviewed the effects and side effects of medications on each patient’s physical health. This was an improvement since the transfer of Shropshire services into the trust.
  • Staff knew how to identify abuse and safeguard young people in line with current recognised guidance and trust policy. Staff followed safeguarding processes and ensured that they highlighted any safeguarding information on the electronic recording system.
  • Young people felt that staff listened to them and provided them with appropriate emotional and practical support. Young people described the staff as caring, supportive and non-judgemental.
  • Staff in the teams provided a range of treatment and care for patients based on national guidance and best practice. Staff supported young people with their physical health and encouraged them to live healthier lives.

Community urgent care services

Requires improvement

Updated 5 July 2019

We rated the service as requires improvement because:

  • The service did not have enough nursing staff with the right qualifications, skills, and training, to keep people safe from avoidable harm and to provide the right care and treatment. The service did not plan for medical emergencies and not all staff understood their roles if one should happen.
  • The service did not monitor the effectiveness of care and treatment and therefore could not use findings to improve them. They did not compare local results with those of other services to learn from them.
  • Managers did not always ensure that staff were competent for their roles. Not all staff received an annual work performance appraisal and the service did not provide structured clinical supervision.
  • The service did not meet accessible information standards. People with communication issues did not have their individual needs met at the units.
  • The service did not use a systematic approach to continually improve the quality of its service and safeguarding high standards of care by creating an environment in which excellence in clinical care would flourish. Complaints were not responded to in a timely way and learning was not shared with staff.
  • Managers at all levels in the service did not always have the right skills and abilities to run a service providing high-quality sustainable care, and the leadership team was new. The service did not have effective systems for identifying risks, planning to eliminate or reduce them, and coping with both the expected and unexpected.

However:

  • Staff kept detailed records of patients’ care and treatment. Records were clear, up-to-date and easily available to all staff providing care. The service followed best practice when prescribing, giving, recording and storing medicines. Patients received the right medication at the right dose at the right time.
  • Staff understood how and when to assess whether a patient had the capacity to make decisions about their care.
  • Staff treated patients with compassion and kindness. They understood the individual needs of patients and supported patients to understand and manage their care, treatment or condition.
  • The trust provided services to ensure people living in more rural areas had a local service that they could access. The service had links with mental health services for people who needed them.

Wards for people with a learning disability or autism

Good

Updated 5 July 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. Staff assessed and managed risk well, managed medicines safely, followed good practice with respect to safeguarding and minimised the use of restrictive practices.
  • 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 cared for in a ward for people with a learning disability (and/or autism) and in line with national guidance about best practice. Staff engaged in clinical audit 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 on the wards. Managers ensured that these staff received training and appraisal. The ward staff worked well together as a multi-disciplinary 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.
  • 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 did not always offer staff support in their roles. Staff were not always receiving regular one to one supervision, and managers were not documenting that supervision had taken place, in line with trust policy.

Forensic inpatient or secure wards

Good

Updated 12 July 2016

  • The service provided good quality, safe environments that promote recovery.
  • We saw a proactive approach to de-escalation which had resulted in low levels of incidents and seclusion use.
  • Patients care plans were holistic, personalised and reflected the patients’ views.
  • Staff in the service were dedicated, caring and understood the individual needs of the patients.
  • A full range of staff made up a skilled and dedicated MDT.

However:

  • Staff had implemented blanket restrictions in response to recent incidents. Many of the restrictions were common place on forensic wards due to associated security measures but needed to be reviewed on a regular basis in order to promote positive risk taking

Community health sexual health services

Good

Updated 12 July 2016

We judged that the service overall was good.

The safety, effectiveness, caring and well led elements of the services were good.

Staff had a very inclusive approach to services. They displayed a caring and supportive attitude when dealing with patients and their carers. Patients could not speak highly enough of the staff that they had encountered.

There were areas for improvement with regards to the responsiveness of the teams in that patients experienced long waits when they attended appointments & Walk-in clinics were cancelled if staff reported sick. There were no separate clinics for groups who might find it difficult to attend general clinics within normal working hours and no outreach clinics or services to engage difficult to reach groups.

In order to make our judgement we visited both locations. We observed how staff of all levels interacted with patients. We spoke with eleven staff, including consultants, nurses, healthcare assistants, and administrative staff. We spoke with five patients or their relatives about their experiences and reviewed records in relation to the planning and running of services.

Community-based mental health services for older people

Outstanding

Updated 12 July 2016

We rated 

community based mental health services for older people as outstanding because:

  • The services were committed to research and innovation. Staff were involved in research projects to improve the efficiency of the services. Staff were innovative in their approach and had invested in developing learning material. They used technology to share their knowledge to help people learn about working with older people in mental health services.
  • The services were responsive to the needs of its staff. Staff routinely received supervision and annual performance reviews. Staff had mandatory training, which managers monitored to ensure compliance. Managers supported staff to develop their skills by funding external and specialist training courses. Staff worked together to develop specialist internal training programmes. There was a culture of leadership at all levels. As a result, staff morale was good.
  • All of the service locations were comfortable, safe, and had suitable facilities for patients including those with mobility concerns. There were secure door entry systems and staff complied with lone working policies and local procedures. There was a firm commitment by all staff to work with patients in their homes or at the nearest possible location if there was a requirement to be seen outside their home.
  • Staff provided high quality treatment and care. Different professionals worked well together to assess and plan for the needs of patients. Patients had up-to-date, individualised care plans. These focussed on helping patients in gaining independence and confidence, avoiding the need for hospital or other residential care.
  • Staff from all disciplines were caring and compassionate. Staff routinely encouraged meaningful engagement with patients and their carers. Service users and carers were also involved in service improvements, for example, staff interviews.
  • Staff used specialist tools to assess and monitor patients who used the services. To aid their recovery, patients had access to specialist psychological therapies, for example, psychological improved access to psychological therapiesIAPT).
  • All services had a good track record on safety and staff managed risk well. Staff undertook risk assessments for each patient. They had been trained in safeguarding and there was cohesive joint working with social services. Staff knew how to report incidents. Managers investigated the incidents and then shared lessons learned with staff.
  • The services had good relationships with their commissioners and made adaptations to service provision when agreed.
  • Each service was well led and managers were approachable and accessible to their staff. They had the skills, experience and motivation needed to drive forward the services. Managers and staff were continually looking for ways to improve outcomes for their patients. The CDEMhome treatment Telford and Wrekinservice received accreditation by the Memory Services National Accreditation Programme (MSNAP)

However:

  • Some specialist services had high caseloads; for example, the memory clinic at CDEM Home Treatment Telford & Wrekin.

Community mental health services with learning disabilities or autism

Good

Updated 12 July 2016

We rated community mental health services for people with learning disabilities as good because:

  • The trust had appropriate staffing levels across the teams and the caseloads were well managed to ensure patient safety.

  • All of the teams completed patients’ comprehensive risk assessments and reviewed and updated them as a multidisciplinary team on a regularly.

  • Staff had completed mandatory training and had the skills and knowledge to meet patients’ needs.

  • Staff knew how to recognise and report incidents and the managers provided them with opportunities to learn lessons from incidents.

  • Staff assessed and supported patients with their physical health care needs and monitored for any undesirable outcomes. Staff treated patients with respect and dignity and involved them in their care and treatment planning.

  • Patients told us they were able and felt free to make a complaint and were confident that the trust would resolve them.

  • Staff worked well with other external organisations such as GPs, acute hospitals, independent organisations, local authorities, police and housing associations to ensure that patients got the right support needed.
  • The managers were knowledgeable and provided good leadership and support to the staff teams.

However:

  • The care records we reviewed showed that staff did not consistently review, update, personalise and address all needs identified in the nursing care plan documentation.

  • Staff did not always carry out assessment of capacity to consent in a consistent way in all teams. Some records where patients had been identified as lacking capacity had no documentation in place.

  • There was a lack of resources to respond promptly and adequately to out of hours crisis situations. The out of hours service had no learning disabilities skilled staff that were available to respond to patients’ needs.

Long stay or rehabilitation mental health wards for working age adults

Good

Updated 12 July 2016

We rated the Long stay rehabilitation mental health wards as good because:

  • We found the ward to be clean, spacious and comfortable with a good quality of furnishings and décor throughout, including a large garden area for fresh air.

  • Staff were caring, kind and compassionate and had a good knowledge of the patient group.

  • Carers received a wide variety of information and had access to carers’ groups and carers’ representatives on the ward.

  • Patients had the choice of a wide range of therapeutic interventions and activities, to aid their recovery.

  • The multidisciplinary team ensured each patient had an effective rehabilitation plan, which was well coordinated and gave patients the opportunity to express their views and participate in their care and treatment.

  • We saw there was a good governance structure in place, and staff met regularly to discuss and reflect on the care and treatment they provided.

Community-based mental health services for adults of working age

Good

Updated 12 July 2016

We rated

South Staffordshire and Shropshire Healthcare NHS Foundation Trust as

good because:’

  • Patients had access to a wide range of professions who offered modern and holistic treatments. This included psychologist, psychiatrists, nurses, occupational therapists and social workers who were trained to deliver dialectical behavioural therapy, cognitive behavioural therapy and eye movement desensitisation and reprocessing therapy.

  • Feedback from patients and carers was very positive about staff and the service overall.

  • Referral to treatment times were good and there was a tiered approach which ensured that patients with an urgent requirement for treatment were assessed quickly.

  • Teams had developed systems of working to ensure that information was shared throughout the team. Leadership was good across all of the services we inspected. Managers were well respected and could demonstrate good knowledge of their team.

However:-

  • The quality of care planning and risk assessments was variable. In some cases these documents were filled out well and contained lots of patient centred information; we did find some however that were out of date or did not contain enough information.

  • There was an issue in some teams linked to social work input. Social work services were externally sourced in some services and this had meant that the social workers changed regularly and did not have the same access to training and development as trust employed social workers.