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Provider: Cambridgeshire and Peterborough NHS Foundation Trust Good

Inspection Summary


Overall summary & rating

Good

Updated 5 September 2019

  • We rated safe as requires improvement and effective, caring, responsive and well-led as good. In rating the trust, we took into account the previous ratings of the nine core services not inspected this time. We rated the trust as good overall for well-led. We rated all of the core services that we inspected on this occasion as good overall. Following this, and taking our previous ratings into account, all bar one of the 16 core services delivered by the trust are rated good overall.
  • We found that leadership was good across the trust. Executive directors and directorate leads were known to most staff and visited services regularly. They provided leadership and the board encouraged feedback from all levels of the organisation. Local leadership across the trust was visible and effective. Staff felt supported by their leaders. The trust supported staff to develop their leadership skills and staff had opportunities for career progression. The trust recognised staff success through individual staff and team awards. Staff morale was good across services that we visited and staff felt respected, supported and valued.
  • The service had enough staff to care for patients and keep them safe. Managers made sure they had staff with a range of skills needed to provide high quality care. They supported staff with appraisals, supervision, and opportunities to update and further develop their skills.
  • Staff understood how to protect patients from abuse, and managed safety well. Staff assessed risks to patients, acted on them and kept good care records. The service controlled infection risk and managed medicines well. The service managed safety incidents and learned lessons from them. Staff collected safety information and used it to improve the service. Patients across the trust told us that they felt safe.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers. Staff involved patients and those close to them as partners in their care and treatment. We received positive feedback from those patients, families and carers that we spoke with about the care and treatment received from staff.
  • The service engaged well with patients and the community to plan and manage services. Trust staff worked well with each other and external organisations to provide care and treatment. The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and, in most cases, did not have to wait too long for treatment. Bed management processes were effective and included daily bed management meetings. Discharge planning was a core part of any inpatient admission.
  • The services met the needs of all patients – including those with a protected characteristic. Staff helped patients with communication, advocacy and cultural and spiritual support. 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. Individual care plans were reviewed regularly and reflected patients’ assessed needs, were personalised, holistic and recovery-oriented. Staff monitored the effectiveness of care and treatment. Treatment was delivered with the legal framework of the Mental Health Act and Mental Capacity Act.
  • Staff had been involved in the development of the trust vision and strategies and, overall, knew of plans to develop their service. Staff were clear about their roles and accountabilities. Managers discussed the values with staff in supervision and appraisals and recruitment processes were based on the values. Staff knew the trust values and demonstrated these in the care that they delivered to patients.
  • The trust had a cohesive governance framework and structure. Service managers attended directorate clinical governance meetings, which fed into the trust wide governance meetings. Local governance meetings discussed team issues, such as incidents, safeguarding, staffing concerns, and identified and shared learning from incidents. Managers fed this learning back to front line staff and patients through team meetings, supervision and learning bulletins. Risk registers were in place at trust, directorate and team level. Staff could escalate concerns and submit items to the trust risk register. Senior trust staff reviewed the trust risk register and non-executive directors openly challenged issues through board and governance meetings. Leaders ran services well using reliable information systems.
  • The trust had committed to improving services by learning from when things went well and when they went wrong, and promoted training, research and innovation. The trust had participated in national improvement and innovation projects and undertook a wide range of quality audits and research. Quality improvement was developing across services. The services treated concerns and complaints seriously, investigated them and learned lessons from the results. Patients told us they knew how to complain.

However:

  • At our inspection of 2018, we had some concerns about the safety at the acute wards. We told the trust that they must address concerns and meet regulation. At this inspection, we found that some of our concerns had not yet been fully addressed. The trust had not ensured that seclusion practice and environments met the requirements of the Mental Health Act Code of Practice and were fully safe. Staff had failed to enforce the trust’s patient search policy in relation to smoking at wards. The trust’s smoke free policy was not being operated at all wards.
  • While the trust had worked to address ligature risks in inpatient services there remained some environmental concerns. At ward S3 in the eating disorder service, an environmental ligature assessment was in place but had not included the garden area. In addition, we found the garden back gate was unlocked. There were also concerns regarding the risk of possible patient absconsion from the garden at the PICU. The clinic rooms within some eating disorder services were messy and grubby and required some essential equipment.
  • Staff at the health-based place of safety at Fulbourn Hospital did not complete or update risk assessments for patients whilst in their care. The service also was not meeting the Royal College of Psychiatrists’ recommendation for doctors assessing patients in the health-based place of safety within three hours. The trust had only one health-based place of safety. When this was in use patients remained in rooms in the local acute trusts.
  • Staff supervision rates and the recording of, were not monitored on a consistent basis by all team managers.
Inspection areas

Safe

Requires improvement

Updated 5 September 2019

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

  • We had concerns about seclusion practice and facilities. The trust had not fully addressed concerns about the layout of the psychiatric intensive care unit’s seclusion room. This could pose a safety risk to patients and staff. Staff had not ensured that all incidents of seclusion had been recorded in line with the Mental Health Act Code of Practice. At Fulbourn, patients had been secluded in rooms other than a designated seclusion room and at Cavell Centre patients been moved across the hospital in restraint holds to access the seclusion room putting patients and staff at increased risk of injury.
  • Staff had failed to enforce the trust’s patient search policy in relation to smoking on wards. The trust’s smoke free policy was not being operated at all wards.
  • Staff at the health-based place of safety at Fulbourn Hospital did not complete or update risk assessments for patients whilst in their care.
  • We found some environmental risks at ward S3 in the eating disorder service. An environmental ligature assessment was in place but had not included the garden area. In addition, we found the garden back gate was unlocked. We raised this with managers during the inspection. Following the inspection, the garden area was risk assessed and the back gate secured.
  • The clinic rooms within some eating disorder services were messy and grubby and required some essential equipment.

However:

  • Overall, wards were safe, clean, well equipped, well furnished, well maintained and fit for purpose. Ward ligature risk assessments had been updated to address all the potential ligature risks on the 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 with the right qualifications, skills, training and experience to keep people safe from avoidable harm and abuse and to provide the right care and treatment. Staff received and were up to date with mandatory training.
  • Staff assessed and managed risks to patients and themselves well. However, the overall number of uses of restrictive interventions was rising. Staff completed risk assessments on admission and updated these regularly and after incidents. Staff responded to changes in patient risks.
  • The services controlled infection well and had few infection incidents. Staff kept equipment and their work area visibly clean. Staff used equipment and control measures to protect patients, themselves and others from infection.
  • Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse, and they knew how to apply it. Staff had the appropriate level of safeguarding training for the services they delivered. The provider had a named nurse and doctor for child safeguarding and the teams had a safeguarding lead.
  • Staff kept detailed records of patients’ care and treatment. Records were clear, up-to-date and generally easily available to all staff providing care.
  • The service used systems and processes to safely prescribe, administer, record and store medicines. Staff regularly reviewed the effects of medications on each patient’s mental and physical health.
  • The trust managed patient safety incidents well. Staff recognised incidents and reported them appropriately. Managers 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. We saw evidence of changes to practice following lessons learned.
  • The trust had developed robust personal safety protocols, including lone working practices, and we saw evidence that staff followed them. Plans were in place to respond to emergencies and major situations. All relevant parties understood their role and the plans were tested and reviewed.

Effective

Good

Updated 5 September 2019

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

  • Staff assessed the physical and mental health of patients. They developed individual care plans which were reviewed regularly through multidisciplinary discussion and updated 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 for adults, staff regularly checked if patients were eating and drinking enough to stay healthy and help with their recovery. Staff assessed and monitored patients regularly to see if they were in pain and requested pain management reviews in a timely way.
  • Staff monitored the effectiveness of care and treatment. Staff used recognised rating scales to assess and record severity and outcomes. They used the findings to make improvements and achieved good outcomes for patients. They also participated in clinical audit, benchmarking and quality improvement initiatives.
  • Policies were aligned and referenced to national guidance, such as National Institute for Health and Care Excellence guidelines. Staff had access to a full range of policies and procedures to support them in their roles and knew who was responsible for providing their national clinical guidance.
  • The teams included or had access to the full range of specialists required to meet the needs of patients under their care. Managers made sure that staff had the range of skills needed to provide high quality care. They supported staff with appraisals, supervision and opportunities to update and further develop their skills. Managers provided an induction programme for new staff.
  • 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. The teams had effective working relationships with other relevant teams within the organisation and with relevant services outside the organisation. Staff held multidisciplinary meetings and patients, carers and commissioners were invited to these. Services had a full range of professional disciplines that provided input into patient care.
  • 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 in inpatient services. Staff ensured patients were able to take their Section 17 leave as agreed. Instances of staff cancelling this leave were rare. Staff knew how to access support and advice on Mental Health Act and Mental Capacity Act concerns.
  • 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 September 2019

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

  • 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.
  • Staff treated each patient with dignity and engaged patients in meaningful activities. Staff recognised and respected the individual needs of patients, including cultural, social and religious beliefs.
  • 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 where appropriate. Patients were encouraged to participate and share their views about their care and treatment in multidisciplinary team meetings. Carers were provided with information on how to access a carer’s assessment. Carers felt supported by staff and involved appropriately in their relatives care and treatment.
  • Staff communicated with patients sensitively, compassionately and through a method they understood. They used a range of methods of communication including using signers, easy read leaflets and by seeking support from carers and families where appropriate.

Responsive

Good

Updated 5 September 2019

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

  • Overall, the services were easy to access. Referral criteria did not exclude patients who would have benefitted from care. Staff assessed and treated patients who required urgent care promptly and patients who did not require urgent care usually did not wait too long to start treatment.
  • Staff followed up patients who missed appointments. Teams took a proactive approach to engaging with patients who found it difficult or were reluctant to engage with services. The needs of different people were considered when planning the delivery of the services.
  • In acute inpatient services, 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. Care and treatment records showed that discharge planning was considered upon admission. Daily bed management meetings took place every week day. These meetings reviewed all wards to identify the availability of beds and potential patient discharges.
  • The design, layout, and furnishings of the community bases and wards supported patients’ treatment, privacy and dignity. In wards each patient had their own bedroom with an ensuite bathroom and could keep their personal belongings safe. Staff supported patients to maintain contact with their families and carers. Wards had quiet areas for patients and rooms either on or off the ward where they could meet visitors. Dedicated child visiting rooms were available.
  • The food provided for patients on the acute wards was of good quality and patients could make hot drinks and snacks at any time.
  • Staff supported patients with activities outside the service, such as work, education and family relationships where appropriate. The trust had a recovery college which provided a wide range of activities, learning and support to patients.
  • Generally, the services met the needs of all patients – including those with a protected characteristic. Staff helped patients with communication, advocacy and cultural and spiritual support. Patients had access to information leaflets in a variety of languages and there was access to a translation service. Staff knew how to access additional information that was not readily available at the service.
  • The services treated concerns and complaints seriously, investigated them and learned lessons from the results and shared these with the whole team and wider service. Patients told us they knew how to complain. Wards had information on the complaints process and this was displayed to patients on ward notice boards and was available to patients. Staff encouraged patients to raise concerns and attempted timely local resolutions. The learning from complaints was disseminated to the wider trust through the lessons in practice bulletin.

However:

  • Waiting times from referral to treatment start exceeded 18 weeks for 24% of patients in community child and adolescent services.
  • The trust had only one health-based place of safety. When this was in use patients remained in rooms in the local acute trusts. Doctors did not assess patients in the health-based place of safety within the three hours recommended by the Royal College of Psychiatrists.
  • Patients calling the First Response team sometimes had to wait a long time for staff to speak to them. Deaf patients could not access the First Response team unless they had additional support.
  • Diagnostic imaging support was not consistently available during opening hours across all minor injury units.

Well-led

Good

Updated 5 September 2019

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

  • The trust had an experienced leadership team with the skills, abilities, and commitment to provide high-quality services. Executive directors and directorate leads were known to staff and visited most services. They provided leadership and the board encouraged feedback from all levels of the organisation. Leadership was developing well in older peoples and adult community services and the children’s and young people’s directorate. This was beginning to pay dividends for example the plans for the children’s hospital were very positive.
  • Local leadership across the trust was visible and effective. Staff felt supported by their leaders. The trust supported staff to develop their leadership skills. Leadership training was available for staff at all levels, irrespective of their job role. The trust provided staff with opportunities for career progression. The trust recognised staff success through individual staff and team awards.
  • Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.
  • The board and senior leadership team had set a clear vision and values that were at the heart of all the work within the organisation. They worked hard to make sure staff at all levels understood them in relation to their daily roles. Staff had been involved in the development of the trust vision and overall knew of plans to develop their service. Staff were clear about their roles and accountabilities. Managers discussed the values with staff in supervision and appraisals and recruitment processes were based on the values. Staff knew the trust values and demonstrated these in the care that they delivered to patients. Staff spoke with passion and commitment and were able to explain how they worked to deliver high quality care within the budgets and resources available to them.
  • The trust strategy was directly linked to the vision and values of the trust. The trust involved clinicians, patients and groups from the local community in the development of the strategy and from this had a clear plan to provide high-quality care with financial stability. Patients and frontline staff were encouraged to make suggestions for improvements at service level. The trust had responded to feedback and changed the way that it worked as a result.
  • The trust had a clear structure for overseeing performance, quality and risk, with board members represented across the directorates. This gave them greater oversight of issues facing the service and they responded when services needed more support. The board reviewed performance reports that included data about the services, which directorate leads could challenge.
  • The trust had a cohesive governance framework and structure. Service managers attended directorate clinical governance meetings, which fed into the trust wide governance meetings. Local governance meetings discussed team issues, such as incidents, safeguarding, staffing concerns, and identified and shared learning. Managers fed this learning back to front line staff and patients through team meetings, supervision and learning bulletins.
  • The trust had improved on many levels since our last inspection although there was work left to do. Recruitment and retention had improved significantly, particularly in the child and adolescent mental health service, eating disorder and First Response services. In addition, staffing metrics such as sickness, stability rate and appraisal had improved. Staff stability was beginning to have an impact on the quality of service delivered.
  • Arrangements were in place for the governance of the Mental Health Act and Mental Capacity Act. The mental health law forum linked to the board and both were sighted on regular performance information. The trust had a section 75 agreement in place with the Local Authority, which worked well. The trust had a positive partnership with the police to deliver section 136 responsibilities.
  • The service had systems for identifying risks, planning to eliminate or reduce them, and coping with both the expected and unexpected. Managers used a systematic approach to continually improve the quality of its services. The service collected, analysed, managed and used information well to support all its activities, using secure electronic systems with security safeguards. Risk registers were in place at trust, directorate and team level. Staff could escalate concerns and submit items to the trust risk register. Senior trust staff reviewed the trust risk register and non-executive directors openly challenged issues through board and governance meetings. Staff were committed to improving services by learning from when things went well and when they went wrong.
  • The trust monitored strategic risks via the board assurance framework and reviewed this regularly. We found this document gave assurance to the board. However, we identified some further areas for improvement and some action required to address previous breach of regulation. The board assurance framework has not included this information.
  • The trust strategy and supporting plans were challenging and innovative, while remaining achievable. The trust aligned its strategy to local plans in the wider health and social care economy and had developed it with external stakeholders. The trust was working with other local health economy stakeholders with an intention to improve the sustainability of the care the system delivered to the population of Peterborough and Cambridgeshire. Reports from external sources, including NHS improvement, commissioners and other stakeholders confirmed the trust was responsive to challenge and worked collaboratively with stakeholders, other local NHS trusts and the third sector to deliver services to patients. Key personnel were actively involved in the sustainability and transformation partnership (STP).
  • The financial information provided to Board was clear and consistent with the monthly financial returns submitted to NHS Improvement. Despite significant financial challenge in the local system, the trust has demonstrated good financial management over previous years. The trust had a surplus of £4.1 million for the financial year 2018/19. The trust also received an additional £4.5 million in funding from the STP to support mental health and community healthcare initiatives. Where cost improvements were taking place there were arrangements to consider the impact on patient care.
  • The trust used research and innovation to improve patient care. The trust participated in a wide range of audits and accreditation schemes and shared learning. The trust led the Collaborations for Leadership in Applied Health Research and Care East of England and was actively involved in many clinical research studies.
  • The trust was developing their quality improvement capacity and capability. The quality strategy had been updated and the first cohort of QSIR (quality, service improvement and redesign) practitioners had been trained. The trust had a three-year plan to cascade training to all front-line staff. However, QI was embryonic and needed significant profile in order to encourage and enthuse staff to improve.
  • We heard about and saw many examples of innovative practice throughout the trust. Staff were enabled to take actions to improve services and to make a difference. The First Response service had developed well and was providing a positive response to people in crisis. Physical health monitoring had improved and was very good particularly in acute mental health services. The smoking cessation team were very impressive. The pilot project undertaken by the tissue viability specialist nursing team in the management of chronic leg oedema was proving positive. We were impressed by the range of developments being planned to enhance the trusts IT capability.

However:

  • The trust had not fully addressed all concerns raised at the last trust inspection of 2018, about the safety at the acute wards. We told the trust that they must address concerns and meet regulation. At this inspection, we found that some of our concerns had not yet been fully addressed. The trust had not ensured that seclusion practice and environments met the requirements of the Mental Health Act Code of Practice and were fully safe.
  • While the trust had worked to address ligature risks in inpatient services there remained some environmental concerns that needed to be addressed.
  • Staff had failed to enforce the trust’s patient search policy in relation to smoking at wards. The trust’s smoke free policy was not being operated at all wards.
  • We also had a number of concerns about the health-based place of safety at Fulbourn Hospital.
  • Work was developing on the equality and diversity agenda but was in early stages. Board members recognised that they had work to do to improve diversity and equality across the trust and at board level. We were however very impressed by the leadership of the trust’s diversity network.
  • Supervision recording was not accurate in all services and at some community teams’ compliance rates were low. This has been an issue at the trust for some years.
  • CAMHS community service had improved on many levels particularly staff recruitment however the waiting list remained an issue. Waiting times from referral to treatment start exceeded 18 weeks for 24% of patients. Staff told us they were very stretched, and in the long term there may be capacity issues.
  • Further work was needed regarding physical interventions. While there was a strategy this required further work and profile to bring about a reduction in physical interventions which were increasing across the trust but particularly in acute services.

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

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

  • All wards were clean, well equipped, well furnished, and well maintained and managers had completed environmental risk assessments. Staff followed good practice in medicines management and monitoring of effects of medication on people’s physical health. The service had enough nursing and medical staff, who knew the patients and received basic training to keep patients safe from avoidable harm.
  • Staff completed mental health assessments at or soon after admission and assessed patient’s physical health needs in a timely manner. Care plans were personalised, holistic and recovery orientated and updated regularly. There was evidence of effective working relationships with other care teams. Staff understood their roles and responsibilities under the Mental Health Act 1983 and supported patients to make decisions on their care for themselves.
  • Staff attitudes and behaviours when interacting with patients were discreet, respectful and responsive, providing patients with help and emotional support and advice at the time they needed it. Staff involved patients and their carers in care planning and risk assessment, care plans were written in patient focused language and evidenced the patient voice.
  • The service met the needs of all patients who used the service and helped patients with communication, advocacy and cultural and spiritual support. Daily bed management meetings took place to review bed pressures, availability of beds and options for patient transfers. Wards had enough rooms for patients to access individual sessions with nursing staff, to receive visitors or to participate in ward-based activities. Staff supported patients to maintain contact with their families and carers and invited them to attend ward reviews where appropriate. The service treated concerns and complaints seriously and acted on these.
  • Staff told us that senior managers were visible on the wards and they knew who senior staff were. Staff knew and understood the trust’s vision and values and said they felt respected and supported by their managers and that morale was good. Staff we spoke with knew the trust had a whistle blowing policy which they would use if they needed to. Governance meetings and local risk registers were in place, staff were able to contribute to these.

However:

  • At this inspection the trust had not made improvements in respect of some areas found at the previous inspection.
  • The layout of the psychiatric intensive care unit’s seclusion room could pose a safety risk to patients and staff. This was because staff had to enter the room to support patients to use the ensuite facility or to open the blind. Staff at the Cavell Centre moved patients across the hospital in restraint holds to access the seclusion room at PICU putting patients and staff at increased risk of injury. At Fulbourn there were occasions where patients had been secluded in rooms other than a designated seclusion room, Staff had not ensured that incidents of seclusion had been recorded in line with the Mental Health Act Code of Practice.
  • Staff had failed to enforce the trust’s patient search policy. We found tobacco, cigarette papers and a lighter in a patient’s bedroom on the treatment ward at the Cavell centre. This posed a fire risk to patients and staff. In addition, at Fulbourn hospital site, staff permitted patients from Mulberry 2 to smoke directly outside the ward. This was against the trust’s no smoking policy.

Community-based mental health services of adults of working age

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

  • Staff assessed the care environment annually for potential risks. Patients who were assessed as being at high risk were always individually risk assessed and supervised in the clinical areas. Staff had access to personal alarms on site in the clinical rooms.
  • Thirty seven of the 43 care plans we reviewed were holistic, personalised and recovery orientated. Thirty-seven of the patients had received a physical health check. Where necessary, staff referred patients to their weekly physical health clinic for regular monitoring.
  • At the time of the inspection, all the workforce in this service had received training in the Mental Capacity Act Level 1 and 89% in the Mental Capacity Act Level 2. When patients lacked capacity, staff made decisions in their best interests, recognising the importance of the person’s wishes, feelings, culture and history.
  • Staff that we spoke with were discreet, respectful and responsive to patients. We observed staff providing practical and emotional support and advice to patients and working flexibly to meet their needs. They understood the individual needs of patients and supported patients to understand and manage their care and treatment.
  • Staff saw urgent referrals quickly, including the same day if required and non-urgent referrals within the trust target time. The service provided a daily duty cover system and all new referrals were reviewed by the duty cover worker.
  • The systems and procedures in place ensured that premises were clean, safe and well-staffed. Patients were assessed and treated well and referrals and waiting times were managed well. Incidents and complaints were reported and investigated, and lessons learned were effectively cascaded to the teams.

However:

  • Not all mandatory training had been completed to the trust’s target of 95% completion. Four courses had failed to exceed 75% compliance.
  • At the Fenland team we found that staff had not kept patient records updated, this included five out of eight risk assessments.

Mental health crisis services and health-based places of safety

Our rating of this service stayed the same. 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 to prevent staff from giving each patient the time they needed. There were no waiting lists and patients who required urgent care were seen promptly. Staff in the crisis and First Response teams assessed and managed risk well and followed good practice with respect to safeguarding.
  • Staff working for the First Response team developed holistic, recovery-oriented care plans informed by a comprehensive assessment and in collaboration with families and carers. They provided a range of treatments that were informed by best-practice guidance and suitable to the needs of the patients. 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 these staff received training, supervision and appraisal. Staff worked well together as a multidisciplinary 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 service was well led, and the governance processes ensured that ward procedures ran smoothly.

However:

  • Staff at the health-based place of safety at Fulbourn Hospital did not complete or update risk assessments for patients whilst in their care. The trust did not ensure that patient information, including information about patient risk, was always up-to-date. Information technology support staff could not be contacted during the night to repair faulty computer systems. This meant staff had to complete paper records and upload them at a later time.
  • Doctors did not assess patients in the health-based place of safety within the three hours recommended by the Royal College of Psychiatrists.
  • Managers did not investigate serious incidents related to the First Response team in a timely manner.
  • Patients calling the First Response team sometimes had to wait a long time for staff to speak to them. Deaf patients could not access the First Response team unless they had additional support.
  • At the crisis and home treatment teams five care plans of nineteen reviewed were not holistic or personalised and did not evidence patient involvement.
  • The provider had not ensured the accuracy of supervision data.

Specialist community mental health services for children and young people

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. 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. Staff managed waiting lists well to ensure that patients who required urgent care were seen promptly. Staff assessed and managed risk well and followed good practice with respect to safeguarding.
  • Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment and in collaboration with families and carers. They provided a range of treatments that were informed by best-practice guidance and suitable to the needs of the patients. Staff engaged in clinical audit to evaluate the quality of care they provided.
  • The teams included or had access to the full range of specialists required to meet the needs of the patients. Managers ensured that staff received training, supervision and appraisal. Staff worked well together as a multidisciplinary team and with relevant services outside the organisation.
  • Staff understood the principles underpinning capacity, competence and consent as they apply to children and young people and managed and recorded decisions relating to these well.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. They actively involved patients and families and carers in care decisions.
  • Staff assessed and treated patients who required urgent care promptly and those who did not require urgent care did not wait too long to be assessed. The criteria for referral to the service did not exclude children and young people who would have benefitted from care.
  • The service was well led and the governance processes ensured that procedures relating to the work of the service ran smoothly.

However:

  • Waiting times from referral to treatment start exceeded 18 weeks for 24% of patients.

Specialist eating disorders service

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

  • All patient areas of the wards were clean and tidy. Clinic rooms at S3 ward were fully equipped with accessible resuscitation equipment and emergency drugs, and clean and well maintained.
  • There were sufficient staff to meet the needs of the patients. Overall, staff knew about any risks to each patient and acted to prevent or reduce risks. Staff identified and responded to any changes in risk to, or posed by, patients promptly. Staff used physical intervention rarely. Staff took part in de-escalation techniques and proactive preventive interventions, which included how to safely restrain a patient with low body mass index. There were effective systems in place for safe management and administration of medication.
  • Services provided a range of treatment in line with best practice guidelines. Overall, there was a holistic approach to assessing, planning, and delivering care and treatment to people who use services. Staff assessed the physical and mental health needs of all patients on admission. The service had access to a range of specialists to meet the needs of the patients. Staff held regular multidisciplinary meetings to discuss patients and improve their care. Staff had a robust understanding of mental capacity and consent. We found clear records around consent to treatment and mental capacity requirements.
  • We observed positive and caring interactions between staff and patients on the wards and in the community. Staff had a good rapport with patients. Staff involved patients and gave them access to their care plans. Staff contacted family members about joining multidisciplinary meetings, ward rounds, or care programme approach meetings.
  • Beds were available when needed to people living in the catchment area. Staff ensured they did not discharge patients until they were ready. The trust ensured facilities promoted recovery, comfort, and dignity. Patients on wards had their own bedroom, which they could personalise. Staff provided a range of information on treatments, local services, patients’ rights, how to contact CQC, and advocacy. We saw information on how to complain displayed around the service.
  • Leaders, at local level, had the right skills, knowledge, and experience to lead their teams. Staff reported they felt supported by leaders. Staff were offered the opportunity to give feedback and input into service development. S3 ward was accredited by the Quality Network for Eating Disorders.

However:

  • Although staff on the wards had undertaken environmental ligature assessments, that for S3 ward had not considered risks in the garden area. Also, the garden back gate had been left unlocked. We raised this with managers during the inspection. Neither community eating disorder services had undertaken environmental risk assessments, although these were in development. The Cambridge community eating disorder service had identified risks in the patient toilet areas and staff were aware of these.
  • The clinic rooms at the Phoenix Centre were disorganised and required cleaning and there were no cleaning records at the Cambridge community eating disorder service. In addition, the clinic room at the Cambridge community eating disorder service did not have disposable gloves or aprons.
  • At S3 ward not all staff were routinely aware of lessons learnt from serious incidents across services.

Community health services for adults

We rated community services for adults as good because:

  • The service had enough staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment. The service managed patient safety incidents well. Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. The service used monitoring results well to improve safety.
  • The design, maintenance and use of facilities, premises and equipment kept people safe. Staff managed clinical waste well. The service controlled infection well and the service had low number of infection incidents.
  • Staff kept detailed records of patients’ care and treatment, they completed and updated risk assessments for each patient and removed or minimised risks. The service used systems and processes to safely prescribe, administer, record and store medicines.
  • The service provided care and treatment based on national guidance and evidence-based practice. Staff gave patients practical support and advice to lead healthier lives. Staff regularly checked if patients were eating and drinking enough to stay healthy and help with their recovery. Staff assessed and monitored patients regularly to see if they were in pain and requested pain management reviews in a timely way.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs.
  • Staff provided emotional support to patients, families and carers to minimise their distress. Staff supported patients to make informed decisions about their care and treatment. They knew how to support patients who lacked capacity to make their own decisions or were experiencing mental ill health. Staff supported and involved patients, families and carers to understand their condition and make decisions about their care and treatment.
  • The service had a vision for what it wanted to achieve and workable plans to turn it into action developed with involvement from staff, patients, and key groups representing the local community. The service planned and provided care in a way that met the needs of local people and the communities served. It was inclusive and took account of patients’ individual needs and preferences. People could access the service when they needed it and received the right care in a timely way.
  • The service engaged well with patients, staff, the public and local organisations to plan and manage appropriate services and collaborated with partner organisations effectively. It was easy for people to give feedback and raise concerns about care received.
  • Managers at all levels in the trust had the right skills and abilities to run a service providing high-quality sustainable care. Managers across the service promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values. All those responsible for delivering care worked together as a team to benefit patients.
  • The service had effective systems for identifying risks, planning to eliminate or reduce them, and coping with both the expected and unexpected. Managers used a systematic approach to continually improve the quality of its services. The service collected, analysed, managed and used information well to support all its activities, using secure electronic systems with security safeguards. Staff were committed to improving services by learning from when things went well and when they went wrong, promoting training, research and innovation.

However:

  • The service did not have robust assurance processes in relation to infection prevention and control audits. The service completed annual hand hygiene audits and did not have any formalised assurance processes in place.

Community urgent care service

We rated community urgent care as good because:

  • The service provided mandatory training in key skills to all staff and made sure most staff had completed it. Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. The service controlled infection risk well. The design, maintenance and use of facilities, premises and equipment kept people safe. Staff assessed risks to patients, acted on them and kept good care records. The service managed patient safety incidents well. The service used systems and processes to safely manage medicines.
  • The service provided care and treatment based on national guidance and evidence-based practice. Staff assessed and monitored patients regularly and gave pain relief in a timely way. All those responsible for delivering care worked together as a team to benefit patients. Staff supported patients to make informed decisions about their care and treatment and followed national guidance to gain patients’ consent.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs. Staff provided emotional support to patients, families and carers, and supported them to understand their condition and make decisions about their care and treatment.
  • The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and received the right care in a timely way.
  • Leaders had the integrity, skills and abilities to run the service. Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

However:

  • Diagnostic imaging support was not consistently available during opening hours across all sites.
Checks on specific services

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

Good

Updated 5 September 2019

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

  • All wards were clean, well equipped, well furnished, and well maintained and managers had completed environmental risk assessments. Staff followed good practice in medicines management and monitoring of effects of medication on people’s physical health. The service had enough nursing and medical staff, who knew the patients and received basic training to keep patients safe from avoidable harm.
  • Staff completed mental health assessments at or soon after admission and assessed patient’s physical health needs in a timely manner. Care plans were personalised, holistic and recovery orientated and updated regularly. There was evidence of effective working relationships with other care teams. Staff understood their roles and responsibilities under the Mental Health Act 1983 and supported patients to make decisions on their care for themselves.
  • Staff attitudes and behaviours when interacting with patients were discreet, respectful and responsive, providing patients with help and emotional support and advice at the time they needed it. Staff involved patients and their carers in care planning and risk assessment, care plans were written in patient focused language and evidenced the patient voice.
  • The service met the needs of all patients who used the service and helped patients with communication, advocacy and cultural and spiritual support. Daily bed management meetings took place to review bed pressures, availability of beds and options for patient transfers. Wards had enough rooms for patients to access individual sessions with nursing staff, to receive visitors or to participate in ward-based activities. Staff supported patients to maintain contact with their families and carers and invited them to attend ward reviews where appropriate. The service treated concerns and complaints seriously and acted on these.
  • Staff told us that senior managers were visible on the wards and they knew who senior staff were. Staff knew and understood the trust’s vision and values and said they felt respected and supported by their managers and that morale was good. Staff we spoke with knew the trust had a whistle blowing policy which they would use if they needed to. Governance meetings and local risk registers were in place, staff were able to contribute to these.

However:

  • At this inspection the trust had not made improvements in respect of some areas found at the previous inspection.
  • The layout of the psychiatric intensive care unit’s seclusion room could pose a safety risk to patients and staff. This was because staff had to enter the room to support patients to use the ensuite facility or to open the blind. Staff at the Cavell Centre moved patients across the hospital in restraint holds to access the seclusion room at PICU putting patients and staff at increased risk of injury. At Fulbourn there were occasions where patients had been secluded in rooms other than a designated seclusion room, Staff had not ensured that incidents of seclusion had been recorded in line with the Mental Health Act Code of Practice.
  • Staff had failed to enforce the trust’s patient search policy. We found tobacco, cigarette papers and a lighter in a patient’s bedroom on the treatment ward at the Cavell centre. This posed a fire risk to patients and staff. In addition, at Fulbourn hospital site, staff permitted patients from Mulberry 2 to smoke directly outside the ward. This was against the trust’s no smoking policy.

Specialist eating disorders service

Good

Updated 5 September 2019

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

  • All patient areas of the wards were clean and tidy. Clinic rooms at S3 ward were fully equipped with accessible resuscitation equipment and emergency drugs, and clean and well maintained.
  • There were sufficient staff to meet the needs of the patients. Overall, staff knew about any risks to each patient and acted to prevent or reduce risks. Staff identified and responded to any changes in risk to, or posed by, patients promptly. Staff used physical intervention rarely. Staff took part in de-escalation techniques and proactive preventive interventions, which included how to safely restrain a patient with low body mass index. There were effective systems in place for safe management and administration of medication.
  • Services provided a range of treatment in line with best practice guidelines. Overall, there was a holistic approach to assessing, planning, and delivering care and treatment to people who use services. Staff assessed the physical and mental health needs of all patients on admission. The service had access to a range of specialists to meet the needs of the patients. Staff held regular multidisciplinary meetings to discuss patients and improve their care. Staff had a robust understanding of mental capacity and consent. We found clear records around consent to treatment and mental capacity requirements.
  • We observed positive and caring interactions between staff and patients on the wards and in the community. Staff had a good rapport with patients. Staff involved patients and gave them access to their care plans. Staff contacted family members about joining multidisciplinary meetings, ward rounds, or care programme approach meetings.
  • Beds were available when needed to people living in the catchment area. Staff ensured they did not discharge patients until they were ready. The trust ensured facilities promoted recovery, comfort, and dignity. Patients on wards had their own bedroom, which they could personalise. Staff provided a range of information on treatments, local services, patients’ rights, how to contact CQC, and advocacy. We saw information on how to complain displayed around the service.
  • Leaders, at local level, had the right skills, knowledge, and experience to lead their teams. Staff reported they felt supported by leaders. Staff were offered the opportunity to give feedback and input into service development. S3 ward was accredited by the Quality Network for Eating Disorders.

However:

  • Although staff on the wards had undertaken environmental ligature assessments, that for S3 ward had not considered risks in the garden area. Also, the garden back gate had been left unlocked. We raised this with managers during the inspection. Neither community eating disorder services had undertaken environmental risk assessments, although these were in development. The Cambridge community eating disorder service had identified risks in the patient toilet areas and staff were aware of these.
  • The clinic rooms at the Phoenix Centre were disorganised and required cleaning and there were no cleaning records at the Cambridge community eating disorder service. In addition, the clinic room at the Cambridge community eating disorder service did not have disposable gloves or aprons.
  • At S3 ward not all staff were routinely aware of lessons learnt from serious incidents across services.

Specialist community mental health services for children and young people

Good

Updated 5 September 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. 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. Staff managed waiting lists well to ensure that patients who required urgent care were seen promptly. Staff assessed and managed risk well and followed good practice with respect to safeguarding.
  • Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment and in collaboration with families and carers. They provided a range of treatments that were informed by best-practice guidance and suitable to the needs of the patients. Staff engaged in clinical audit to evaluate the quality of care they provided.
  • The teams included or had access to the full range of specialists required to meet the needs of the patients. Managers ensured that staff received training, supervision and appraisal. Staff worked well together as a multidisciplinary team and with relevant services outside the organisation.
  • Staff understood the principles underpinning capacity, competence and consent as they apply to children and young people and managed and recorded decisions relating to these well.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. They actively involved patients and families and carers in care decisions.
  • Staff assessed and treated patients who required urgent care promptly and those who did not require urgent care did not wait too long to be assessed. The criteria for referral to the service did not exclude children and young people who would have benefitted from care.
  • The service was well led and the governance processes ensured that procedures relating to the work of the service ran smoothly.

However:

  • Waiting times from referral to treatment start exceeded 18 weeks for 24% of patients.

Community urgent care services

Good

Updated 5 September 2019

We rated the service as good because:

  • The service provided mandatory training in key skills to all staff and made sure most staff had completed it. Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. The service controlled infection risk well. The design, maintenance and use of facilities, premises and equipment kept people safe. Staff assessed risks to patients, acted on them and kept good care records. The service managed patient safety incidents well. The service used systems and processes to safely manage medicines.
  • The service provided care and treatment based on national guidance and evidence-based practice. Staff assessed and monitored patients regularly and gave pain relief in a timely way. All those responsible for delivering care worked together as a team to benefit patients. Staff supported patients to make informed decisions about their care and treatment and followed national guidance to gain patients’ consent.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs. Staff provided emotional support to patients, families and carers, and supported them understand their condition and make decisions about their care and treatment.
  • The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and received the right care in a timely way.
  • Leaders had the integrity, skills and abilities to run the service. Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

However:

  • Diagnostic imaging support was not consistently available during opening hours across all sites.

Mental health crisis services and health-based places of safety

Good

Updated 5 September 2019

Our rating of this service stayed the same. 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 to prevent staff from giving each patient the time they needed. There were no waiting lists and patients who required urgent care were seen promptly. Staff in the crisis and First Response teams assessed and managed risk well and followed good practice with respect to safeguarding.
  • Staff working for the First Response team developed holistic, recovery-oriented care plans informed by a comprehensive assessment and in collaboration with families and carers. They provided a range of treatments that were informed by best-practice guidance and suitable to the needs of the patients. 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 these staff received training, supervision and appraisal. Staff worked well together as a multidisciplinary 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 service was well led, and the governance processes ensured that ward procedures ran smoothly.

However:

  • Staff at the health-based place of safety at Fulbourn Hospital did not complete or update risk assessments for patients whilst in their care. The trust did not ensure that patient information, including information about patient risk, was always up-to-date. Information technology support staff could not be contacted during the night to repair faulty computer systems. This meant staff had to complete paper records and upload them at a later time.
  • Doctors did not assess patients in the health-based place of safety within the three hours recommended by the Royal College of Psychiatrists.
  • Managers did not investigate serious incidents related to the First Response team in a timely manner.
  • Patients calling the First Response team sometimes had to wait a long time for staff to speak to them. Deaf patients could not access the First Response team unless they had additional support.
  • At the crisis and home treatment teams five care plans of nineteen reviewed were not holistic or personalised and did not evidence patient involvement.
  • The provider had not ensured the accuracy of supervision data.

Community-based mental health services for adults of working age

Good

Updated 5 September 2019

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

  • Staff assessed the care environment annually for potential risks. Patients who were assessed as being at high risk were always individually risk assessed and supervised in the clinical areas. Staff had access to personal alarms on site in the clinical rooms.
  • Thirty seven of the 43 care plans we reviewed were holistic, personalised and recovery orientated. Thirty-seven of the patients had received a physical health check. Where necessary, staff referred patients to their weekly physical health clinic for regular monitoring.
  • At the time of the inspection, all the workforce in this service had received training in the Mental Capacity Act Level 1 and 89% in the Mental Capacity Act Level 2. When patients lacked capacity, staff made decisions in their best interests, recognising the importance of the person’s wishes, feelings, culture and history.
  • Staff that we spoke with were discreet, respectful and responsive to patients. We observed staff providing practical and emotional support and advice to patients and working flexibly to meet their needs. They understood the individual needs of patients and supported patients to understand and manage their care and treatment.
  • Staff saw urgent referrals quickly, including the same day if required and non-urgent referrals within the trust target time. The service provided a daily duty cover system and all new referrals were reviewed by the duty cover worker.
  • The systems and procedures in place ensured that premises were clean, safe and well-staffed. Patients were assessed and treated well and referrals and waiting times were managed well. Incidents and complaints were reported and investigated, and lessons learned were effectively cascaded to the teams.

However:

  • Not all mandatory training had been completed to the trust’s target of 95% completion. Four courses had failed to exceed 75% compliance.
  • At the Fenland team we found that staff had not kept patient records updated, this included five out of eight risk assessments.

Community health services for adults

Good

Updated 5 September 2019

We rated community services for adults as good because:

  • The service had enough staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment. The service managed patient safety incidents well. Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. The service used monitoring results well to improve safety.
  • The design, maintenance and use of facilities, premises and equipment kept people safe. Staff managed clinical waste well. The service controlled infection well and the service had low number of infection incidents.
  • Staff kept detailed records of patients’ care and treatment, they completed and updated risk assessments for each patient and removed or minimised risks. The service used systems and processes to safely prescribe, administer, record and store medicines.
  • The service provided care and treatment based on national guidance and evidence-based practice. Staff gave patients practical support and advice to lead healthier lives. Staff regularly checked if patients were eating and drinking enough to stay healthy and help with their recovery. Staff assessed and monitored patients regularly to see if they were in pain and requested pain management reviews in a timely way.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and took account of their individual needs.
  • Staff provided emotional support to patients, families and carers to minimise their distress. Staff supported patients to make informed decisions about their care and treatment. They knew how to support patients who lacked capacity to make their own decisions or were experiencing mental ill health. Staff supported and involved patients, families and carers to understand their condition and make decisions about their care and treatment.
  • The service had a vision for what it wanted to achieve and workable plans to turn it into action developed with involvement from staff, patients, and key groups representing the local community. The service planned and provided care in a way that met the needs of local people and the communities served. It was inclusive and took account of patients’ individual needs and preferences. People could access the service when they needed it and received the right care in a timely way.
  • The service engaged well with patients, staff, the public and local organisations to plan and manage appropriate services and collaborated with partner organisations effectively. It was easy for people to give feedback and raise concerns about care received.
  • Managers at all levels in the trust had the right skills and abilities to run a service providing high-quality sustainable care. Managers across the service promoted a positive culture that supported and valued staff, creating a sense of common purpose based on shared values. All those responsible for delivering care worked together as a team to benefit patients.
  • The service had effective systems for identifying risks, planning to eliminate or reduce them, and coping with both the expected and unexpected. Managers used a systematic approach to continually improve the quality of its services. The service collected, analysed, managed and used information well to support all its activities, using secure electronic systems with security safeguards. Staff were committed to improving services by learning from when things went well and when they went wrong, promoting training, research and innovation.

However:

  • The service did not have robust assurance processes in relation to infection prevention and control audits. The service completed annual hand hygiene audits and did not have any formalised assurance processes in place.

Community health inpatient services

Good

Updated 21 June 2018

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

Community mental health services with learning disabilities or autism

Good

Updated 21 June 2018

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

Child and adolescent mental health wards

Good

Updated 21 June 2018

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

Wards for people with a learning disability or autism

Good

Updated 21 June 2018

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

Community health services for children, young people and families

Good

Updated 21 June 2018

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

Forensic inpatient or secure wards

Good

Updated 21 June 2018

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

Wards for older people with mental health problems

Requires improvement

Updated 21 June 2018

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

Long stay or rehabilitation mental health wards for working age adults

Good

Updated 13 October 2015

We gave an overall rating for long stay/rehabilitation mental health wards for working age adults of good because:

  • Patients we spoke with were very positive about the wards and the care they received from staff and told us they were involved in their care, were listened to and treated with kindness and respect.

  • Staff morale was high with staff positive about the leadership of both the trust and their line managers. There were good systems in place to monitor staff performance and the productivity of the ward.

  • There was good management of risk, learning from incidents and complaints. Staff shortfalls were managed safely with an active recruitment programme for staff vacancies. Staff were up to date with mandatory training and were able to undertake further training; for example, four nurses had trained in tissue viability and wound management.

  • Patients had a full range of activities.

However:

  • There was a general lack of psychology input which meant staff did not always have sufficient input to help them manage more complex and challenging patients.

  • Oak 4 did not have a dedicated low stimulus/de-escalation area.

Community-based mental health services for older people

Good

Updated 13 October 2015

We gave an overall rating for community-based mental health services for older people of good because:

  • The support provided by older persons CMHTs, CRHTs, day therapy service and memory clinic was thoughtful, respectful and considered patients individual needs. The teams worked closely with carers and relatives and with other agencies. Teams were appropriately staffed, and where there were vacancies appropriate arrangements were in place to manage these.

  • Risk assessments were undertaken on every patient during the initial assessment. This information was reviewed regularly. However, in one instance we found that the risk assessment had not been updated. All incidents were reported and staff had opportunities to discuss and learn from these. However, managers at some sites did not have access to detailed information relating to incident reporting within their team and two staff reported that when reporting incidents they were not always clear how to rate the incident.

  • Comprehensive assessments were completed in a timely manner, and care records were up to date. However, a small number of care records did not evidence that patients had been given a copy of their care plan. Some care plans were not recovery orientated, did not consider holistic needs or contain the patients’ views. One patient we spoke with told us that they were not aware of the out of hours arrangements for contacting services.

  • Staff were using NICE and other best practice guidance. Each team was made up of the full range of disciplines, who were regularly supervised and supported to undertake appropriate training. Staff demonstrated a good understanding of the MHA and MCA. Urgent referrals were seen quickly and non-urgent referrals within acceptable timescales.
  • The trust had effective governance procedures in place. Key performance indicators were used to gauge the performance of individual teams, and staff had the ability to submit items to the directorate and trust risk registers. Staff spoke highly of their managers and their supportive teams. Staff were open and transparent with patients when things went wrong. Some teams were involved in innovative research programmes. Whilst a wide range of information leaflets were available at each site we visited, these were not available in a range of formats or languages.