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Provider: Pennine Care NHS Foundation Trust Requires improvement

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

Reports


Inspection carried out on 28 August 2018 to 25 October 2018

During a routine inspection

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

  • We rated safe, effective and well led as requires improvement, caring and responsive as good. In rating the trust, we considered the previous ratings of the services we did not inspect this time in the overall rating.
  • Of the five services reviewed at this inspection we rated two as good, wards for older people with mental health problems and community dental services. We rated three as requires improvement community urgent care, mental health crisis services and health based places of safety and Acute wards for adults of working age and psychiatric intensive care units (PICU's).
  • Overall considering previously rated services and those undertaken at the inspection we rated one of the trust’s 17 services as outstanding, 10 as good and six as requires improvement.
  • Although several practice areas within the trust and service delivery had demonstrated improvement many of these quality improvements had not been in place for a sufficient time to demonstrate sustainability and assure the trust of the success of their implementation.
  • There was a risk of patients being harmed as there was limited assurance about safety measures in place to meet patient’s needs. There was an inconsistent practice throughout the organisation with lessons learnt not reliably shared with staff to support improvements in practice.
  • Staff did not consistently feel equality and diversity were promoted in their day to day work and when looking at opportunities for career progression. There had been a deterioration in the previous 12 months for black, minority ethnic staff (BME) staff in recruitment, experience of bullying and opportunity within the trust.
  • The leadership, governance and culture did not consistently support the delivery of high-quality person-centred care. There was a variety of practice throughout the trust with limited sharing of best practice when identified.
  • Whilst there were clear systems in relation to the implementation of the of the Mental Health Act 1983 and its amendments 2007 (MHA) and the Mental Capacity Act 2005 (MCA); these were inconsistently understood and adhered to throughout the trust.
  • There were four breaches identified in relation to the fundamental standards.

However:

  • The rating of effective, caring and well led in wards for older people with mental health problems improved from requires improvement to good.
  • There was a clear commitment from the trust that the priority was its service to the local population and a drive to improve the quality of services. There was evidence of a significant positive change in the culture within the trust led by the senior leadership team.
  • Patients were supported by staff, treated with dignity and respect and were involved as partners in their care.
  • Overall most patients’ needs were met through the way care was organised and delivered.
  • There had been an increase in support to the divisions to develop their own communication and engagement strategies and encouraged staff to get involved with projects affecting the future of the trust.


CQC inspections of services

Service reports published 28 January 2019
Inspection carried out on 28 August 2018 to 25 October 2018 During an inspection of Community dental services Download report PDF | 471.64 KB (opens in a new tab)Download report PDF | 1.74 MB (opens in a new tab)
Inspection carried out on 28 August 2018 to 25 October 2018 During an inspection of Mental health crisis services and health-based places of safety Download report PDF | 471.64 KB (opens in a new tab)Download report PDF | 1.74 MB (opens in a new tab)
Inspection carried out on 28 August 2018 to 25 October 2018 During an inspection of Community urgent care services Download report PDF | 471.64 KB (opens in a new tab)Download report PDF | 1.74 MB (opens in a new tab)
Inspection carried out on 28 August 2018 to 25 October 2018 During an inspection of Acute wards for adults of working age and psychiatric intensive care units Download report PDF | 471.64 KB (opens in a new tab)Download report PDF | 1.74 MB (opens in a new tab)
Inspection carried out on 28 August 2018 to 25 October 2018 During an inspection of Wards for older people with mental health problems Download report PDF | 471.64 KB (opens in a new tab)Download report PDF | 1.74 MB (opens in a new tab)
See more service reports published 28 January 2019
Service reports published 30 August 2017
Inspection carried out on 19 to 21 June 2017 and 27 June 2017 During an inspection of Wards for older people with mental health problems Download report PDF | 342.99 KB (opens in a new tab)
Inspection carried out on 12 to 14 June 2017 During an inspection of Acute wards for adults of working age and psychiatric intensive care units Download report PDF | 275.79 KB (opens in a new tab)
Service reports published 9 December 2016
Inspection carried out on 14-16 June 2016 During an inspection of Long stay or rehabilitation mental health wards for working age adults Download report PDF | 299.42 KB (opens in a new tab)
Inspection carried out on 13 to16 and 30 June 2016 During an inspection of End of life care Download report PDF | 289.42 KB (opens in a new tab)
Inspection carried out on 31 May 2016 and 1 June 2016 During an inspection of Community-based mental health services for adults of working age Download report PDF | 335.69 KB (opens in a new tab)
Inspection carried out on 31 May and 1 June 2016 During an inspection of Community-based mental health services for older people Download report PDF | 369.51 KB (opens in a new tab)
Inspection carried out on 14 to 17 June 2016 During an inspection of Community health services for adults Download report PDF | 365.94 KB (opens in a new tab)
Inspection carried out on 14 - 16, 22 June 2016 During an inspection of Wards for older people with mental health problems Download report PDF | 439.22 KB (opens in a new tab)
Inspection carried out on 14 June 2016 During an inspection of Child and adolescent mental health wards Download report PDF | 445.3 KB (opens in a new tab)
Inspection carried out on 13 to 17 June 2016 During an inspection of Community health services for children, young people and families Download report PDF | 461.44 KB (opens in a new tab)
Inspection carried out on 27th June 2016 During an inspection of Substance misuse services Download report PDF | 289.95 KB (opens in a new tab)
Inspection carried out on 13 – 29 June 2016 During an inspection of Specialist community mental health services for children and young people Download report PDF | 319.14 KB (opens in a new tab)
Inspection carried out on 14, 15 and 16 June 2016 During an inspection of Community mental health services with learning disabilities or autism Download report PDF | 366.95 KB (opens in a new tab)
Inspection carried out on 13-16 June 2016 During an inspection of Mental health crisis services and health-based places of safety Download report PDF | 392.45 KB (opens in a new tab)
Inspection carried out on 13th to 17th June 2016 During an inspection of Community health inpatient services Download report PDF | 368.5 KB (opens in a new tab)
Inspection carried out on 14 to 16 June 2016 During an inspection of Acute wards for adults of working age and psychiatric intensive care units Download report PDF | 404.41 KB (opens in a new tab)
Inspection carried out on 14 -15 June 2016 During an inspection of Forensic inpatient or secure wards Download report PDF | 358.68 KB (opens in a new tab)
See more service reports published 9 December 2016
Inspection carried out on 13 to 16 June 2016

During a routine inspection

We rated Pennine Care NHS Foundation Trust as requires improvement overall because:

We rated six services as requires improvement, these were:

  • Wards for older people with mental health problems
  • Acute wards for working age adults and psychiatric intensive care units
  • Community based mental health services for adults of working age
  • Mental health crisis services and mental health-based places of safety
  • Community end of life care
  • Community health services for adults

The main areas for improvement were:

  • Department of Health guidance on same sex accommodation was breached in the wards for older people and the acute wards for working age adults and psychiatric intensive care units
  • Trust medicines management policy was not being observed in a number of the services we visited in recording, cancelling medicines, care plans for when required medicine and rapid tranquillisation. Temperatures for fridges and rooms were above the recommended guidance from the manufacture or the trust policy to safely store medicines. There were date expired needles and syringes in an emergency anaphylaxis kit in the Heywood, Middleton and Rochdale school nurse service at Milnrow Health Centre.
  • On Saffron ward, for older people, staff had not considered the need for a legal framework where people over the age of 16, who lack capacity, were subject to restrictions, which may amount to a deprivation on liberty. Consideration of best interest as detailed in the Mental Capacity Act Code of Practice, the Mental Health Act or the Deprivation of Liberty Safeguards. Patients’ capacity to consent to admission and treatment was not being assessed for patients admitted to Saffron ward. There were a number of patients on this ward who were not detained under the Mental Health Act, but lacked the capacity to consent to an informal admission. These patients were subject to restrictions, interventions and control without the safeguards of an appropriate legal framework.
  • In a number of the core services we visited we found that mandatory training was under the trust minimum. In some services less than 75% of staff had completed basic life support and intermediate life support. This would have a detrimental effect on patients of that service who required life support in an emergency.
  • Supervision policy was not being adhered to fully across the trust, in some files we could not find any records to show that supervision had taken place for up to two years and in some we could not find any record of supervision at all. Staff in Trafford Healthy Young Minds team were not receiving separate clinical and management supervision.
  • The trust had different recording systems across the trust, some of which do not link in with the trust electronic notes system. This meant that not all teams were able to access patient care records easily and some services used a mixture of paper and electronic records.
  • In two of the home care and treatment teams, there were missing care plans and risk assessments and physical health check recordings. One children’s nutritional and dietetics service did not keep contemporaneous, accurate and complete records, there were missing pages, unsigned entries and missing reviews and follow-ups.

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

However,

The main good points were:

  • Staff were on the whole responsive, respectful and caring and professional in their attitudes and worked to support the patients.
  • Staff had a good understanding of safeguarding and the trust had systems and policies in place to support the reporting of incidents.
  • The trust had business continuity plans in place across services for emergencies and staff were aware of them and in some instances had used them.
  • Staff we spoke to told us they were supported by their managers in accessing training opportunities that were suitable to their needs and development.
  • The trust had a well-structured governance pathway to monitor outcomes for patients.
  • My shared pathway was being used to promote recovery and positive outcomes for patients across the trust.
  • We found that multidisciplinary team working was well developed across the trust both internally and in developing links with external agencies.
  • The trust were working in conjunction with others when planning services for patients and had developed working relationships with other agencies.
  • The trust had a range of facilities that provided and promoted recovery, comfort, dignity and confidentiality to the patients and families in their care.
  • The trust had clear vision and values and staff were aware of these and could articulate their understanding.

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.


Mental Health Act Commissioner reports

Each year, we visit all NHS trusts and independent providers who care for people whose rights are restricted under the Mental Health Act to monitor the care they provide and check that patients' rights are met. Immediate concerns raised by patients on those visits are discussed, if appropriate, with hospital staff.

Our Mental Health Act Commissioners may carry out a number of visits to each provider over a 12-month period, during which they talk to detained patients, staff and managers about how services are provided. In the past, we summarised themes from the visits and published an annual statement followed by the provider's response where applicable. We are looking at different ways to indicate the outcomes of our monitoring in the future.