You are here

Provider: Cambridgeshire and Peterborough NHS Foundation Trust Good

Reports


Inspection carried out on 20 May to 14 Jun 2019

During a routine inspection

  • 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.


CQC inspections of services

Service reports published 5 September 2019
Inspection carried out on 20 May to 14 Jun 2019 During an inspection of Specialist eating disorders service Download report PDF (opens in a new tab)Download report PDF (opens in a new tab)
Inspection carried out on 20 May to 14 Jun 2019 During an inspection of Specialist community mental health services for children and young people Download report PDF (opens in a new tab)Download report PDF (opens in a new tab)
Inspection carried out on 20 May to 14 Jun 2019 During an inspection of Acute wards for adults of working age and psychiatric intensive care units Download report PDF (opens in a new tab)Download report PDF (opens in a new tab)
Inspection carried out on 20 May to 14 Jun 2019 During an inspection of Community urgent care services Download report PDF (opens in a new tab)Download report PDF (opens in a new tab)
Inspection carried out on 20 May to 14 Jun 2019 During an inspection of Mental health crisis services and health-based places of safety Download report PDF (opens in a new tab)Download report PDF (opens in a new tab)
Inspection carried out on 20 May to 14 Jun 2019 During an inspection of Community-based mental health services for adults of working age Download report PDF (opens in a new tab)Download report PDF (opens in a new tab)
Inspection carried out on 20 May to 14 Jun 2019 During an inspection of Community health services for adults Download report PDF (opens in a new tab)Download report PDF (opens in a new tab)
See more service reports published 5 September 2019
Service reports published 21 June 2018
Inspection carried out on 12 March 2018 During an inspection of Acute wards for adults of working age and psychiatric intensive care units Download report PDF (opens in a new tab)
Inspection carried out on 12 March 2018 During an inspection of Community health inpatient services Download report PDF (opens in a new tab)
Inspection carried out on 12 March 2018 During an inspection of Community mental health services with learning disabilities or autism Download report PDF (opens in a new tab)
Inspection carried out on 12 March 2018 During an inspection of Child and adolescent mental health wards Download report PDF (opens in a new tab)
Inspection carried out on 12 March 2018 During an inspection of Wards for people with a learning disability or autism Download report PDF (opens in a new tab)
Inspection carried out on 12 March 2018 During an inspection of Specialist community mental health services for children and young people Download report PDF (opens in a new tab)
Inspection carried out on 12 March 2018 During an inspection of Community health services for children, young people and families Download report PDF (opens in a new tab)
Inspection carried out on 12 March 2018 During an inspection of Forensic inpatient or secure wards Download report PDF (opens in a new tab)
Inspection carried out on 12 March 2018 During an inspection of Wards for older people with mental health problems Download report PDF (opens in a new tab)
See more service reports published 21 June 2018
Service reports published 13 October 2015
Inspection carried out on 18 to 22 May 2015 During an inspection of Specialist community mental health services for children and young people Download report PDF (opens in a new tab)
Inspection carried out on 18 to 22 May 2015 During an inspection of Wards for older people with mental health problems Download report PDF (opens in a new tab)
Inspection carried out on 18 - 22 May 2015 During an inspection of Child and adolescent mental health wards Download report PDF (opens in a new tab)
Inspection carried out on 18 to 22 May 2015 During an inspection of Long stay or rehabilitation mental health wards for working age adults Download report PDF (opens in a new tab)
Inspection carried out on 18 to 22 May 2015 During an inspection of Community-based mental health services for adults of working age Download report PDF (opens in a new tab)
Inspection carried out on 18 to 22 May 2015 During an inspection of Mental health crisis services and health-based places of safety Download report PDF (opens in a new tab)
Inspection carried out on 18 to 22 May 2015 During an inspection of Community health services for children, young people and families Download report PDF (opens in a new tab)
Inspection carried out on 18 to 22 May 2015 During an inspection of Wards for people with a learning disability or autism Download report PDF (opens in a new tab)
Inspection carried out on 18 to 22 May 2015 During an inspection of Forensic inpatient or secure wards Download report PDF (opens in a new tab)
Inspection carried out on 18 - 22 May 2015 During an inspection of Community-based mental health services for older people Download report PDF (opens in a new tab)
Inspection carried out on 18 - 22 May 2015 During an inspection of Acute wards for adults of working age and psychiatric intensive care units Download report PDF (opens in a new tab)
See more service reports published 13 October 2015
Inspection carried out on 12 March 2018

During a routine inspection

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

  • 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 five services not inspected this time. We rated the trust overall for well-led as good.
  • At this inspection, we rated seven core services as good, one specialist mental health service (The eating disorder service) as good and two core services as requires improvement. In rating the trust, we took into account the previous ratings of the four services not inspected this time. Therefore, following this most recent inspection, 12 of the trust’s services are rated as good, and two as requires improvement.
  • The trust managed patient safety well. Staff had recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned. When things went wrong, staff apologised and gave patients honest information and suitable support. The trust applied the Duty of Candour appropriately. Those serious incident reports reviewed included clear communication with and attempts to communicate with family and carers throughout the investigation process. Staff had training on how to recognise and report abuse and applied it. The trust had effective systems for identifying risks and planning to eliminate or reduce them. The trust was committed to improving services by learning from when things go well and when they went wrong. Staff training and service development was prioritised.
  • Staff kept clear records of patients’ care and treatment. Care and treatment records were clear, up-to-date and available to all staff providing care. The trust provided care and treatment based on national guidance. Patients had access to psychological support and occupational therapy. The physical healthcare needs of inpatients’’ with mental health needs were met. Patients in community health services benefitted from the support provided by staff.
  • Trust staff worked well with each other and external organisations to provide care and treatment to patients based on national guidance. Bed management processes were effective and included daily bed management meetings.
  • Staff completed Mental Health Act paperwork correctly. There was administrative support to ensure these records were up to date and regular audits took place.
  • Systems for the safe management and administration of medicine were in place. Incidents and errors within the pharmacies were reported and investigated and shared at team meetings to ensure consistency across different sites. The pharmacy team reviewed serious incident reports when medicines were involved. The trust had subscribed to the Choice and Medication website to support patients including at the point of discharge.
  • Positive feedback was received from those patients, families and carers spoken with about the care and treatment received from staff. Patients told us that they felt safe across the trust.
  • The trust promoted a person-centred culture and staff involved patients and those close to them as partners in their care and treatment. Staff provided positive emotional support to patients.
  • Local leadership across the trust was strong, visible and effective. Executive directors were known to staff and visited services. They provided inspirational leadership and the board encouraged feedback from all levels of the organisation. Staff were particularly positive about the chief executive’s approach. The responsiveness of the trust to issues raised during the inspection was immediate.

However:

  • There were a number of environmental issues that prevented the trust from offering safe services. The current ward ligature risk assessments did not address all the potential ligature risks on the wards. The environment in which the LD and autism community intensive support team saw patients had areas that patients could access that were unsafe. Wards had some outstanding maintenance tasks. Staff environmental checks on the wards were not thorough. Staff did not effectively implement the trust’s smoke free policy on some wards. The trust took immediate action to address these concerns once these were identified.
  • Staff did not always record information thoroughly. Staff supervision rates and the recording of; were not monitored on a consistent basis by ward managers. Some seclusion records were incomplete and these did not reflect the interventions provided by staff during seclusion episodes.
  • In the specialist community mental health services for children and young people, the trust did not routinely monitor the risk of those young people waiting to receive treatment. Staff had not followed the trust policy on the recording of risk. The trust had not ensured that staff followed their new access policy on patients who did not attend appointments. Patients, who failed to attend appointments, were not followed up. Some staff were not aware of their responsibilities under the Mental Capacity Act and relating to capacity assessment and Gillick competencies.
  • Managers did not monitor the arrangements in place for the safe management of alarms, keys and access cards. Staff were taking these away from the hospital which meant that these could be misplaced and access gained by unauthorised persons.

Inspection carried out on 18 to 22 May 2015

During a routine inspection

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

We rated Cambridgeshire and Peterborough NHS Foundation Trust as good overall because:

  • Services were effective, responsive and caring. Where concerns had arisen the board had taken urgent action to address areas of improvement.
  • Staff treated people who used the service with respect, listened to them and were compassionate. They showed a good understanding of people’s individual needs.
  • Admission assessment processes and care plans, including for physical healthcare, were good.
  • The board and senior management had a vision with strategic objectives in place and staff felt engaged in the improvement agenda of the trust. Performance improvement tools and governance structures were in place and had brought about improvement to practices.
  • Morale was found to be good in most areas and staff felt supported by local and senior management. There was effective team working and staff felt supported by this.
  • The trust had undertaken positive engagement action with service users and carers.
  • A good range of information was available for people and the trust was meeting the cultural, spiritual and individual needs of patients.
  • The inpatient environments were conducive to mental health care and recovery.
  • The bed management system within adult and older people’s services was effective.
  • Information systems were in place to ensure effective information sharing across teams.
  • Services were using evidence based models of treatment and made reference to National Institute for Health and Care Excellence (NICE) guidelines.
  • The trust had an increasingly good track record on safety in the previous 12 months. Effective incident, safeguarding and whistleblowing procedures were in place. Staff felt confident to report issues of concern. Learning from events was noted across the trust.
  • The trust had met its targets required under the Department of Health’s ‘Positive and Proactive Care: reducing the need for restrictive interventions’ agenda. There had also been a decreasing level of restraint and seclusion in the previous 12 months.
  • Medicines management was effective and pharmacy was embedded into ward practice.
  • Arrangements were in place to ensure effective use of the Mental Health Act and Mental Capacity Act
  • There was a commitment to quality improvement and innovation.

However:

  • We had some concerns about restrictive practice in some areas of the trust. However, the trust was engaging in work to reduce these episodes. In addition not all environments where people were secluded were appropriate.
  • Staffing issues in some community children’s teams and acute services were affecting waiting targets.

  • There were clear arrangements for ensuring that there was single sex accommodation on the majority of wards. However, improvement was needed to ensure that arrangements for managing mixed sex accommodation at Maple 1 ward were followed to ensure the privacy of patients.

  • There were ligature points in some inpatient services and observation should be improved in some areas.
  • Not all patients had easy access to psychological therapies.
  • Consent to treatment procedures needed improvement.

Intelligent Monitoring

We use our system of intelligent monitoring of indicators to direct our resources to where they are most needed. Our analysts have developed this monitoring to give our inspectors a clear picture of the areas of care that need to be followed up.

Together with local information from partners and the public, this monitoring helps us to decide when, where and what to inspect.


Joint inspection reports with Ofsted

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


Organisation Review of Compliance