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Provider: Midlands Partnership NHS Foundation Trust Good

We are carrying out checks on locations registered by this provider. We will publish the reports when our checks are complete.

Inspection Summary


Overall summary & rating

Good

Updated 12 July 2016

We found South Staffordshire & Shropshire Healthcare NHS Foundation Trust to be performing at a level that led to a judgement of good.

We found the trust to be well led at board level and this was reflected in the leadership demonstrated throughout the services provided. The joined up approach from ward to board was tangible and this had a direct impact upon the quality of services and patient experience. We were highly impressed by the senior leadership team individually and as a cohesive unitary board.

We saw some examples of the trust going above and beyond to ensure that services reflected the needs of patients; an example of this being the running of 8 Community Managed Libraries by the Trust in partnership with Staffordshire County Council in order to ensure that patients have access to work experience. The initiative has also assisted in reducing stigma towards people with mental health problems and promoting the wellbeing agenda for local communities.

We found that the core services to be of a consistently high quality and the passion and skills of the staff were fundamental to achieving quality outcomes for people who use the services. We found outstanding practice in the community mental health services for older people where staff demonstrated care and responsiveness that ensured patients and their families were fully involved in decisions about their care.

We did however find that mental health crisis services & health based places of safety require improvements to be made in order to ensure that provision is safe and responsive. Responsiveness within community health (sexual health) services was also not conducive to meeting peoples’ needs.

We will be working with the trust to agree an action plan to assist them in improving the standards of care and treatment.

Inspection areas

Safe

Good

Updated 12 July 2016

  • Wards and environment in community services were clean and with appropriate furnishings. Clinical areas maintained to a high standard. Cleaning records were up to date and demonstrated that the environments were clean. They were welcoming for patients with lots of information posted on noticeboards.

  • Caseload numbers were manageable and allowed staff the opportunity to spend time on direct care. All the CRHT teams were able to respond quickly to sudden deterioration in patients’ health.

  • Staff training and supervision percentages were above trust key performance indicators.

  • There were effective measures in place to ensure that information from incidents and investigations was cascaded to all staff.

  • There was enough staff to operate the services safely and effectively.

  • Clinical rooms were clean and fit for purpose. Staff carried out regular checks on emergency equipment to ensure it was safe for use at any time. Wards adhered to infection control principles. Staff carried out regular audits.

  • Staff had undertaken comprehensive ligature risk assessments of all care environments and individual patients to reduce any risks identified by lack of clear lines of sight or ligature risks.

  • Risk assessments were comprehensive, completed on admission and reviewed daily in a review meeting involving the whole care team.

  • Pharmacists and pharmacist technicians visited wards to check patients’ prescription charts and ensure medicines were available. They were involved in patients’ medicine requirements from the point of admission through to discharge. This included undertaking a check of patients’ medicines on admission to check what current medicines the patient was prescribed. Checks were made to ensure that any known allergies or sensitivities to medicines were recorded accurately on patients’ prescription charts. When a patient was discharged, the pharmacy provided a medicine information leaflet specific to the named patient. This information provided a summary of what each medicine was for, how to take it, side effects and any warnings or cautions.

  • Staff knew how to record incidents and learned lessons that improved the future safety of patients.

  • Medical revalidation process was in line with national implementation and procedures. There was rapid access to psychiatrists in all areas we inspected.

  • Specialist services had received specific management of aggression and violence training relating to the specific patient group they worked with.

However:

  • The management medicine was inconsistent across services. Issues we found included medicines not given to patients with serious physical health issues. Intramuscular medication given to patients who refused to take prescribed medication was not recorded as a rapid tranquilisation. There were several episodes where we found the rapid tranquilisation policy was not followed by staff.

  • Staff did not follow local policy or the Mental Health Act Code of Practice that supported safe practice when documenting the observations and decision-making in the use of seclusion.

Effective

Good

Updated 12 July 2016

  • The trusts safeguarding processes were aligned with partner agencies in order to ensure that patients were protected from abuse

  • Staff participated in clinical audits and monitored outcomes to improve performance throughout the trust by using a recognised tool. Staff on older people’s wards used a variety of recognised guidance and tools to promote a culture of safe and quality care.

  • Staff had a good understanding of the Mental Health Act. Patients knew their rights and advocacy services had a visible presence on all the wards.

  • Care records contained up to date, personalised, holistic, recovery-oriented care plans. Care record documents were available in easy-read (accessible) format for patients with a learning disability.

  • Consent to treatment documents (T2/T3) showed the appropriate e-BNF (electronic British National Formulary) sections.

  • Staff followed best practice guidance when dealing with young people; applying Gillick and Fraser principles in assessing capacity to provide consent for patients under the age of 16 years old.

  • National guidance in relation to waiting times and appointments met. Patients who were able to access walk-in clinics were seen within two hours and patients requiring appointments were all offered appointments within the 48 hour period.

  • Patient outcomes were measured using recognised tools such as HONOS & ‘My shared pathway’.

  • Staff undertook clinical audits in areas such as care records, the provision of nursing 1:1 time, medicine management and the security of the environment.

  • Staff had forged effective working relationships with teams outside of the service such as social services and in primary care.

  • The mental health services offered modern therapies in line with guidance issued by the national institute for health and care excellence.

  • The teams consisted of a range of disciplines such as medical staff, nurses, support workers, psychologists and occupational therapists. There were several examples of effective multidisciplinary working both internally and externally of the trust

  • Staff received regular supervision and appraisal. Training levels were high across all services we inspected. Staff received training in the Mental Health Act (MCA) and Mental Capacity Act (MCA).

Caring

Good

Updated 12 July 2016

  • The trust was proactive in ensuring that the patient voice was heard through the patient experience team. The trust also engaged with several patient representative groups. Teams within the trust were proactive in involving patients in different aspects of the service including taking part in staff recruitment.

  • We consistently observed staff treating with patients’ with kindness, respect, compassion and empathy.

  • Carers and former patients we spoke to were positive in their views of staff and stated that they were fully involved in the care of their family member and felt well supported.Most patients we spoke to were also positive in their views of staff and told us that they were involved in their care planning, and staff took time to speak to them about care plans and treatments.

  • Information was available to patients on all aspects of their care and staff gave a comprehensive information pack to patients on admission. Carers received information about the service.

  • Patients gave regular feedback on the quality of care on the acute wards through surveys and participation in weekly community meetings.

  • In 2015, the Patient Led Assessment of the Care Environment (PLACE) awarded the service scores for privacy, dignity and wellbeing above the average result for all NHS trusts.

  • Care records demonstrated that staff involved patients in regular discussions about their care.

  • Advocacy services were accessible to patients and had a regular presence on the wards.

  • The Trust had taken on the running of eight community managed libraries in partnership with Staffordshire County Council to both support the local community and provide voluntary experience for patients of working and interacting with the community.

Responsive

Good

Updated 12 July 2016

  • Staff were knowledgeable and confident when discussing the complaints procedure. All staff were aware of the trusts policy. Learning lessons shared with staff from complaints and investigations. They were discussed in team meetings for reflection, learning and any actions. Patients we spoke with told us the trust listens to and learns from complaints. Several patients and carers shared examples of concerns they had experienced and how staff managed and resolved these and the outcomes and actions communicated to them.

  • Wards effectively managed bed occupancy. The average length of stay on wards was short; there were few delays in discharges across the service and beds available to patients in crisis.

  • The wards offered patients a good range of activities and space for therapeutic and social activity.

  • Children and young people services delivered in a way that met the needs of the local population. Services were flexible and the needs of different children and young people were taken into account so that they were able to access the right care at the right time.

  • Most of the trust’s services had the quantity and range and of rooms and equipment needed to support treatment and care. Patients could personalise their bedrooms if they wished and wards provided secure storage for patients’ belongings.

  • There were activities provided on all inpatient wards. The majority of activity took place on weekdays. However, there were activity co-ordinators who worked flexibly over the weekends to provide activities for inpatients.

However:

  • Access to the health based place of safety (HBPoS) at George Bryan Centre compromised patient safety, privacy, dignity and confidentiality. Police and ambulance crew escorted patients into the HBPoS through the acute ward corridors. The lack of space in both the HBPoS at George Bryan Centre and St Georges hospital would affect the ability of staff to carry out physical interventions safely, if required.

  • The approved mental health practitioner (AMHP) and doctor did not always attend within three hours as recommended in the MHA Code of Practice. Patients waited in HBPoS for long periods before being seen for assessment.

Well-led

Good

Updated 12 July 2016

  • There was a clear vision and a set of values understood and supported by most staff in the trust.

  • There was effective use of risk registers to bring record current and emerging risks or concerns to the attention and monitoring of senior management.

  • The trust had a robust governance structure that supported the learning from incidents, complaints and service user feedback.

  • The trusts children and adult safeguarding team are significantly engaged with local authority boards at all levels, which underpins effective co-working, shared practice and transparency to eternal scrutiny.

  • The trust had a systematic programme of clinical audit used to monitor quality and systems that identified where the organisation should take action. The trust partakes in a number of audits both internal and external. The trust also participates in national quality improvement programmes such as AIMS.

  • Commissioners were well engaged with the trusts senior management and met regularly to discuss and monitor services and performance.

  • Staff spoke positively of the chief executives connection to services and staff. The trust board had a cohesive group of executive and non-executive directors with varied skills and experience who were proactive within board meetings.

  • Staff morale was mostly good across the services in the trust. We observed motivated and committed staff who told us that they felt they made a difference and were proud of the work they did.

  • Leaders were knowledgeable, skilled, and the trust provided opportunities to develop. In the NHS staff survey 2014, on a scale of 1-4,

    trust employees scored a mean of 4 for feeling they had support from immediate managers compared to the national average score of 3.8’

  • There was evidence of services using a variety of tools and methods to monitor and improve quality.

  • We observed the several teams and services to be proactive, forward thinking and innovative.
Checks on specific services

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

Good

Updated 8 November 2017

In the last inspection in March 2016, we recommended that the trust should ensure that patients placed in the corridors of opposite gender were offered support, have risk assessments and care plans to manage the risks. Since that inspection we received information that caused us to re-inspect focussed on these key concerns.

• On this inspection, we found that the trust had not fully addressed these issues.Patients on Birch ward were placed in the opposite gender sleeping corridors without a robust risk assessment that follows a detailed management/care plan on how the risk of sexual safety was safely managed. There was no documented evidence to show that regular reviews were taking place.

• The trust did not ensure that the action plans put in place as a result of lessons learnt were followed up and monitored to ensure that changes in practice were fully embedded across the services.

• Staff in Laurel ward were not carrying out intermittent observations 5-15 minutes according to the trust policy.

However:

• The trust had changed two wards Pine and Laurel to single gender wards in response to concerns about sexual safety on the wards.

• Staffing levels were maintained to sufficient numbers to provide safe care.

Wards for older people with mental health problems

Good

Updated 12 July 2016

We rated South Staffordshire and Shropshire Healthcare NHS Foundation trust as good because:

  • The wards were clean and safe with sufficient staff to meet patients’ needs. They were patient and age friendly, with a variety of rooms and activities. Risks to patients were monitored and managed effectively.

  • Staff used evidence-based tools and assessments to measure needs and risk. Clinicians took part in audits to improve the quality of care. Staff had access to additional training for their role to improve clinical effectiveness.

  • Staff treated patients and carers with dignity and respect. Staff were enthusiastic, positive and had understood the needs of patients and how to meet them. All patients and carers we spoke with were positive about the care and treatment they had received.

  • Staff felt well supported and supervised, staff appraisal rates were good. Mandatory training rates met trust requirements.

However:

  • Medication errors relating to unavailable medicines were not being consistently reported as an incident and as such learning in this area was difficult to achieve.

  • Three women occupied bedrooms on the male corridor on Holly ward. This practice was not meeting the requirements for single sex accommodation.

Specialist community mental health services for children and young people

Good

Updated 12 July 2016

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

  • Patients had access to a wide skill mix across all services, which gave them a holistic service.
  • Feedback from patients and families was very positive about staff. They said they cared for patients and showed an understanding of the issues they faced.
  • Staff responded to patients in crisis through an out of hours self-harm duty rota where they assessed patients quickly following admission to paediatric wards within acute hospital settings.
  • Teams had received level three safeguarding training and staff showed they understood how and when to make a referral. Teams felt able to ask the trust’s lead nurse in safeguarding for advice and guidance.
  • Staff attended weekly referral and allocation meetings so all cases received a regular review. This helped staff to respond to the changing needs of patients and they could offer urgent appointments. This meant staff worked well both internally and externally as part of a multi-disciplinary team.
  • Staff said leadership was good and they could approach managers for advice and guidance at any time. The managers’ ensured staff received regular management and clinical supervision and annual appraisals.
  • Staffing levels were appropriate to the needs of the service with few vacancies and low levels of absence.

However

  • Practitioners did not always update risk assessments on a regular basis. Staff reported the electronic recording system was not easy to use and could be time consuming taking time away from direct support.
  • Staff often sent care plans as part of a formal letter for other professionals rather than to patients and families. This approach to care planning was at times disjointed and not always in an accessible format.
  • Staff completed most initial assessments within the agreed target of eight weeks however, there was a long wait following this for access to some therapies.

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.

Community health services for children, young people and families

Good

Updated 12 July 2016

We rated this service as good overall because:

  • We saw good examples of infection control practices by staff across the Children and Young People (CYP) services.

  • Staffing levels across CYP services were appropriate to the needs of the patient group and staff had training and support to do their job effectively.

  • There were a robust safeguarding process in place with good safeguarding supervision and training for all staff.

  • Staff within most services used electronic records effectively and where services used paper records, we saw they were up to date and clear with the relevant information accessible.

  • We saw that staff provided care that was centred on the child and individualised across all CYP services. Children, young people and their families were treated with dignity and respect by staff and were involved as partners in their care.

  • Care and treatment followed evidence based practice and we saw good arrangements around consent.

  • People we spoke to during the inspection were very happy with the quality of the service and spoke highly of the staff providing care.

However:

  • Staff told us and we saw a lack of joint working across services. There were limited care pathways or processes in place for children who were transitioning to adult services.

  • Services had not listed some of their main issues as risks. Senior managers did not keep records of how they managed these risks or whether they were monitored on a regular basis.

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 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.

Forensic inpatient/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-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.

Mental health crisis services and health-based places of safety

Requires improvement

Updated 12 July 2016

We rated mental health crisis services and health-based place of safety as Required improvement because:

  • The level of cleanliness in the clinic room at Telford & Wrekin was of a poor standard and we saw that cleaning schedules were not always being adhered to.

  • The lack of space in both the HBPoS at George Bryan Centre and St Georges hospital would influence the ability of staff to safely carry out physical interventions if necessary.

  • The responsiveness of approved mental health practitioners and doctors attending the HBPoS following the admission of patients was variable.

  • There was no disabled access to the toilets in the HBPoS’ at George Bryan Centre and St Georges hospital.

  • Within the Telford & Wrekin team, there was no robust process in place to discuss themes of incidents or to ensure that learning was consistently embedded.

However:

  • Staffing levels were sufficient to ensure that safety was not compromised. We also saw that mandatory training completion was above the trust target.

  • Skilled professionals saw urgent referrals quickly; staff responded as quickly as possible to any deterioration in patients’ mental health.

  • Care plans, risk assessments and physical health checks were of a good quality and there was clear evidence of patient involvement in their formulation.

  • We saw evidence of effective inter-agency working in assessing and supporting patients detained under section 136 at the HBPoS.

  • Patients and their families were complimentary about the attitudes of staff and the support that they received. Staff showed that they understood the individual needs of patients and could describe how they supported patients with a wide range of needs.

  • Staff had good knowledge of the Duty of Candour. We saw written letters of apology were given patients and their families were things had gone wrong.

  • Good governance arrangements were in place locally, which supported the quality, performance and risk management of the services. Key performance indicators were utilised in order to monitor performance.

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.

Wards for people with a learning disability or autism

Good

Updated 12 July 2016

We rated Oak House as good because:

  • Documentation to support the delivery of care was strong. Full recording of peoples care and support needs was in place with a person centred, MDT approach to care planning, and risk assessment.
  • The physical health needs of the patient group dictated that a strong emphasis be placed on the monitoring and early warning indicators of any deterioration of physical symptoms. There was strong evidence of ongoing physical health monitoring and access to specialist care if required.
  • There was strong leadership at ward level and we were impressed by the effect that this had on staff morale & engagement
  • Staff consistently demonstrated a caring attitude towards patients and their families
  • Feedback from patients and their families reflected the perceptible cohesion of the MDT to deliver high quality care.