• Organisation
  • SERVICE PROVIDER

Leicestershire Partnership NHS Trust

This is an organisation that runs the health and social care services we inspect

Overall: Requires improvement read more about inspection ratings
Important: Services have been transferred to this provider from another provider
Important: Services have been transferred to this provider from another provider
Important: We are carrying out checks on locations registered by this provider. We will publish the reports when our checks are complete.

All Inspections

10 January, 11 January, 17 January

During an inspection of Community health services for adults

Our rating of this location improved. We reviewed 3 key questions; safe, effective, and well led. Safe, effective and well led were rated good.

We rated it as good because:

  • Staff provided good care and treatment to patients and gave pain relief when they needed it. Managers monitored the effectiveness of the service and ensured staff were competent. Staff worked well together for the benefit of patients, advised them how to lead healthier lives, supported them to make decisions about their care, and had access to good information.
  • The service provided care and treatment based on national guidance and ensured staff were competent for their roles. Staff were up to date with mandatory training. Staff had regular supervision and appraisal. Staff had access to a range of specialist training.
  • Staff understood how and when to assess whether a patient had the capacity to make decisions about their care. Staff always had access to up-to-date, accurate and comprehensive information on patients’ care and treatment.
  • Patients underwent a thorough assessment of need and care plans were based on best practice and recovery oriented. Assessments were completed in collaboration with patients and carers and progress was regularly reviewed in line with the patient’s care plan.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity, and understood the individual needs of patients. Patients spoke highly about the care they received from the staff within each of the older adult services. Patients spoke highly about district nurses. Staff actively involved patients, their families and carers in care decisions.
  • There was an established governance structure within the service. There were clear systems of accountability and team managers were actively involved in the operational delivery of the service. There was a clear statement of visions and values. Staff knew and understood the vision, values, and strategic goals of the service.
  • Safeguarding processes were in place which reflected national guidance and were understood by all staff. There was a clear structure of reporting and responsibility for safeguarding.

However

  • Due to the high number of staff vacancies, the provider sometimes used agency staff who were not employed by one of the trust’s approved agencies. Not all these members of staff had access to the electronic health records of the patients they were caring for.
  • Due to the high number of staff vacancies, high use of agency staff and acuity of patients, staff morale was low in some areas and there was a high level of sickness and turnover of staff. Managers were aware of this and were taking action to address these concerns.

Background to inspection

The trust was formed in 2002 to provide mental health, learning disability and substance misuse services. In April 2011 the trust merged with Leicester City and Leicestershire County and Rutland Community Health Services, because of the national transforming community services agenda. This enabled joined up mental health and physical health care pathways to advance health and wellbeing for the people and communities of Leicester, Leicestershire, and Rutland.

Leicester Partnership NHS Trust (LPT) provides community health services to over one million people across Leicester City, Leicestershire, and Rutland. Just under one third live in Leicester City and approximately four percent live in Rutland. The community health services for adults are part of the community health services directorate and provides community nursing services, including specialist respiratory and heart failure nurses, community therapy services including rehabilitation and a falls prevention service.

Most patients cared for by community health services for adults are over 65 years of age. Services provide care and support to help patients stay well and prevent future problems, support them to live at home and provide treatment when they are ill to help them recover. Community health services for adults are delivered from a wide range of locations including trust premises and third-party locations delivering services to local communities. In Rutland, health services are delivered in partnership with the local authority where an integrated model of health and social care is being delivered.

The trust provides community nursing teams which are located throughout the city and county areas with the three main areas being the city, the east and the west. In total, there are 8 community nursing teams (hubs) across Leicester, Leicestershire, and Rutland. Each area has teams which provide scheduled care and unscheduled care.

We previously inspected community health services for adults in November 2017. The CQC rated community health services for adults as requires improvement overall, with safe, effective, responsive, and well led rated requires improvement. Caring was rated as good.

This was a focused inspection, which was undertaken to review pressure ulcer care and management following an increase in incidents relating to pressure care.

How we carried out this inspection

To fully understand the experience of people who use services, we asked the following three questions:

  • Is it safe?
  • Is it effective?
  • Is it well-led?

Before the inspection visit, we reviewed information that we held about the location.

During the inspection visit, the inspection team:

  • Reviewed the quality of the service environment and observed how staff were caring for patients
  • Spoke with 6 patients who were using the service
  • Attended 4 home visits and during the visit spoke with 4 patients
  • Spoke with 6 carers
  • Attended a triage meeting and observed 2 patients being reviewed at clinic
  • Spoke with 17 staff members; including, senior matron, matrons, team leader senior district nurse, issue viability nurse, senior nurses for complex care, healthcare assistants and administrative staff
  • Reviewed 8 care and treatment records of the patients
  • Carried out a specific check of medicines management and clinical equipment
  • Reviewed a range of policies, procedures and other documents relating to the running of the service.

The inspection team consisted of 1 CQC Deputy Director of Operations, 3 CQC Inspectors, and an Expert by Experience

You can find information about how we carry out our inspections on our website: https://www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection.

What people who use the service say

  • All patients we spoke with spoke highly about district nurses. One patient stated they, “Can’t fault the community nurses”. Another patient described the community nurses as, “Very good”, adding that, “You can’t fault any of the nurses”. A third patient told us, “All the community nurses are very good but all very different, they all know exactly what to do.” Another patient told us, “All of my nurses are angels every one of them”.
  • However, one patient told us some of the agency staff visiting did not have the same level of skills required to ensure things were done to the same standard as when they were visited by the trust employed staff. A second patient told us that they were, “Confident with the district nurses but not so with bank nurses, still feel safe but a little concerned with ability” adding that, “Something doesn’t feel right”.
  • One carer advised that they had raised concerns about a nurse, who hadn’t followed the dressing regime. This nurse no longer visited the patient.

12 April 2022

During an inspection of Mental health crisis services and health-based places of safety

We carried out this unannounced focused inspection of adult liaison psychiatry services as part of a system wide inspection of Urgent and Emergency Care provision in the Leicester, Leicestershire and Rutland Integrated Care System. Urgent and emergency care services across England have been and continue to be under sustained pressure. In response, the Care Quality Commission undertook a series of coordinated inspections, monitoring calls and analysis of data to identify how services in a local area work together to ensure patients receive safe, effective and timely care.

Adult liaison psychiatry services are provided by Leicestershire Partnerships NHS Trust (LPT), the mental health trust in the Leicester, Leicestershire and Rutland Integrated Care System. Adult liaison psychiatry services are delivered by the mental health trust across three acute hospital sites at Leicester Royal Infirmary, Leicester General Hospital and Glenfield Hospital. At this inspection, we looked at adult liaison psychiatry services at the Leicester Royal Infirmary site. We looked at how the adult liaison psychiatry service affected patient flow, admissions to hospital and discharges from the Leicester Royal Infirmary hospital as part of the system wide healthcare.

The adult psychiatric liaison service provides assessment and treatment for adults between the ages of 16 to 65, who experience mental health problems in the context of physical illness. Adult liaison psychiatry is categorised under Mental Health Core service of Mental Health Crisis and Health Based Places of Safety (HBPoS), as it is provided by the mental health trust, Leicestershire Partnership NHS Trust.

This was a focused inspection. We did not rate this inspection. We looked at the domains of safe, effective and responsive and we did not inspect all of the key lines of enquiry. We did not inspect the whole core service.

We inspected adult psychiatric liaison services as part of Mental Health Crisis and Health Based Places of Safety core service. We did not inspect the following areas of this core service:

  • Crisis Resolution and Home Treatment teams (CRHT)
  • Health Based Places of Safety.

We did not rate this service at this inspection. The previous rating of requires improvement remains. We found:

  • Staff working for the adult psychiatric liaison 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 worked well together as a multidisciplinary team and with relevant services outside the organisation.
  • The service did not exclude patients who would have benefitted from care. The team engaged with patients who found it difficult or were reluctant to engage with mental health services.
  • There was a full complement of staff with no vacancies.
  • All areas were very clean, fresh smelling and fit for purpose. All assessment rooms had good visibility.
  • Staff we spoke with were proud to work within the adult psychiatric liaison team and proud to show us the work they did and the service they provided. They were constantly looking at ways to improve their work and the patient experience of the service.

However, we noted one issue that could be improved:

  • We found the average wait times for patients presenting with a mental health crisis or specific mental health needs were between 1.5 hours and 1.9 hours. This was because the EDU ‘batch’ refer sending four or five referrals at a time rather than when they arrive. We were aware the local commissioning groups had not set targets for wait times.

How we carried out the inspection

We spoke with six members of staff including matrons, team leaders and mental health practitioners and reviewed all the assessment areas the adult psychiatric liaison team uses. We reviewed data and documentation including three patients’ care records and risk assessments.

You can find further information about how we carry out our inspections on our website: https://www.cqc.org.uk/what-we-do/how-we-do-our-job/what-we-do-inspection.

What people who use the service say

We did not speak to any patients using the service at the time of the inspection.

28 February 2022

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

We carried out this unannounced focused inspection because at our last inspection in 2021, we had concerns about the quality of services and issued enforcement action. At this inspection we assessed what work the Trust had undertaken, as a result of the enforcement action we issued. The Trust was required to make significant improvements in some key areas.

We did not inspect all key questions in all domains because this inspection was undertaken specifically to assess progress the Trust had made to meet legal requirements after the last inspection. We are monitoring the progress of improvements to other key lines of enquiry in other services following the inspection in 2021 and will re-inspect them as appropriate.

The action we told the Trust to take following the last inspection were:

  • to improve ways in which patients could call for help in an emergency
  • to take action to eradicate shared sleeping arrangements (dormitories).
  • to improve ways in which patients’ privacy and dignity were protected.

We inspected some but not all key question in the domains of safe, effective, caring, responsive and well led in one service. The key questions inspected were in relation to the areas of concern in the enforcement action we took following the last inspection.

At this inspection, we visited the following service:

  • acute wards for adults of working age and psychiatric intensive care units.

We re-rated the ‘Safe’ and ‘Responsive’ key question only at this inspection. The ‘Safe’ key question rating improved from inadequate to requires improvement. The ‘Responsive’ key question rating improved from requires improvement to good. Other key questions not inspected at this inspection will be addressed at future inspections.

Effective, Caring and Well-led were not re-rated.

The overall rating of requires improvement for acute wards for adults of working age and psychiatric intensive care units remains the same.

The Trust overall rating of requires improvement remains the same.

The Trust have met all actions required in the enforcement action issued at the last inspection.

We found:

  • On Watermead and Thornton wards, all patients now had a way to summon help in an emergency. Across all wards at the Bradgate Mental Health Unit (BMHU), all patients had now been risk assessed for a wrist worn personal alarm, which could be used to summon help in an emergency. A paper-based risk assessment form was now in place for every patient which showed staff had considered the need for a wrist worn alarm. The form included the patient’s involvement in the decision. Where patients had declined an alarm, staff documented this decision. Patients who wore wrist alarms, knew how they worked.
  • Fixed alarms in toilets and bathrooms were now insitu.
  • The Trust had completed major environmental works to eliminate shared sleeping arrangements (dormitories), in the timeframe outlined in their action plan. One ward remained with shared sleeping accommodation (dormitories) at the time of our inspection. However, this ward (Aston) was relocating to a newly refurbished, single occupancy bedroom ward so that refurbishment could start. This meant, all wards at the Bradgate Mental Health Unit (BMHU) would be single occupancy.
  • Patients had sufficient space to store personal belongings. Every bedroom had a floor to ceiling wardrobe and a chest of drawers. Every patient had access to lockable storage and additional storage space in separate room on the ward.
  • Staff were aware of the importance to protect patients’ privacy and dignity. Every bedroom door now had a permanent sign which reminded staff to knock before entering.

However:

  • Staff did not routinely upload paper-based risk assessments for patient wrist alarms into the patient’s electronic care record as per Trust policy.
  • Staff had not consistently completed care plans in the electronic patient record for those patients who wore wrist alarms.
  • Staff did not test the wrist worn alarms or fixed room alarms regularly on all wards and record the outcome as per Trust policy.

How we carried out the inspection

We carried out this inspection to follow up on enforcement action we issued at the last inspection in 2021. These concerns were in relation to some of the key questions of Safe, Effective, Caring, Responsive and Well led. Therefore, our report does not include all the information usually found in a comprehensive report. We have only re-rated the ‘Safe’ and ‘Responsive’ key questions for one service.

The rating of ‘Safe’ improved from inadequate to requires improvement. The rating of ‘Responsive’ improved from requires improvement to good. All other key questions were not re-rated.

The overall rating of requires improvement for this service remains the same.

The Trust overall rating of requires improvement remains the same.

During our inspection, our inspection team carried out the following activities across wards:

  • interviewed 11 staff including charge nurses, healthcare assistants and two senior managers
  • spoke with 14 patients
  • visited six wards of seven wards and reviewed the environment and bedroom spaces
  • reviewed governance systems and processes in place to deliver safe care and treatment
  • reviewed minutes of team meetings, MDT meetings and board papers and reviewed a range of policies, procedures and other documents relating to the running of the service
  • reviewed 35 care records, including risk assessments and care plans.

What people who use the service say

One patient told us how well balanced the system was to assess if patients needed a wrist band alarm. They told us the process was not discriminatory or had a hierarchy that singled out patients who needed an alarm. They told us they felt having an alarm was accepted by all. And made them feel safe. Another patient told us they had been risk assessed twice for a wrist band and had declined but understood the purpose of the wrist alarms. One patient on Aston ward said their visitor had not been given an alarm to wear. One patient told us they had agreed to have an alarm but could decide when they wore it; it depended on how they felt each day.

Some patients reported agency staff still did not knock on their bedroom doors.

11, 12 and 17 June 2019

During an inspection looking at part of the service

We did not rate this inspection. The ratings from the inspection which took place in November 2018 remain the same.

This was a focused, unannounced inspection, to follow up on enforcement action we issued to the trust after our last inspection in November 2018.  We have not inspected against other requirement notices that were issued at the same time; therefore, all requirement notices from the last inspection remain in place. 

At the last inspection, we issued enforcement action because the trust did not have systems and processes across services to ensure that the risk to patients were assessed, monitored, mitigated and the quality of healthcare improved in relation to:

  • Access to treatment for specialist community mental health services for children and young people
  • Maintaining the privacy and dignity of patients and concordance with mixed sex accommodation
  • Environmental issues
  • Fire safety issues
  • Medicine management
  • Seclusion environments and seclusion paper work
  • Risk assessment of patients
  • Physical health care
  • Governance and learning from incidents.

The trust was required to make significant improvements in the following core services where we found concerns in the areas listed above:

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

  • Wards for people with a learning disability or autism

  • Long stay or rehabilitation mental health wards for working age adults

  • Specialist community mental health services for children and young people.

At this inspection, we found the following areas the trust needed to improve:

Significant improvements had been made to the environments at most wards. It was clear to see the difference the investment and improvements had made since our last visit. The majority of repairs and maintenance issues highlighted within the warning notice at the Bradgate Mental Health Unit had been fixed or resolved. A programme of work was due to start in forthcoming months, for wards yet to be refurbished. New systems were in place for staff to report any repairs or maintenance issues.

There were improvements in ligature risk assessments. All ward ligature risk assessments had been reviewed and were located on each ward together with mitigation summaries. Staff completed risk assessments that were thorough and had been reviewed following incidents.

The trust had improved how staff recorded patients physical healthcare, and monitored patients who had ongoing physical healthcare problems. The trust had recruited two registered general nurses with dedicated time to focus on individual healthcare plans at Stewart House and The Willows. There were effective systems in place to audit and monitor physical health care records.

The trust had improved medicines management. This included labelling, disposal, reconciliation and ward level audit. All wards had developed their own systems to improve medicines management in their areas. Medicine management training sessions had been undertaken with inpatient ward sisters and charge nurses.

Some improvements to address the no smoking policy at the Bradgate Mental Health Unit wards were seen. Smoking cessation had been successful across most wards in the Bradgate Mental Health Unit.The trust had re-drafted the smoke free policy following on patient and staff consultation. Patients were offered smoking cessation treatments, nicotine replacement therapy (NRT), or free vapes. 

Fire safety was much improved, with fire drills carried out regularly. An escape plan was developed with patients (PEEP) who may not be able to reach an ultimate place of safety unaided, or within a satisfactory period of time in the event of any emergency. We saw patients that needed a PEEP had a plan in place.

Some improvements were seen in seclusion documentation and seclusion environments. The trust had new seclusion paperwork implemented in May 2019. A full audit was scheduled for the end of June 2019. Improvements had been made to seclusion areas at The Willows Acacia and Maple wards.

The trust had maintained patients privacy and dignity at Short Breaks Services. The trust ceased mixed sex breaches by maintaining male and female only weeks. Patients privacy and dignity had been addressed at The Willows, Cedar and Acacia wards with changes made to male and female wards.

The trust had ensured patients privacy and dignity were maintained when receiving physical health observations at the Bradgate Mental Health Unit. Staff had set clear guidelines on where and how physical health observations were completed on wards.

The trust had significantly reduced waiting times and the total numbers of children and young people waiting for assessments. The trust had reviewed existing systems and processes identified improvements and implemented changes. Funding had been secured for increased staff with specialist skills. There had been a change in leadership and a review of key performance indicators (KPIs) with commissioners. The trust had developed new processes and redesigned and improved data validation.

We saw the trust had developed oversight and a vision on how to improve the nine key areas identified by the warning notice. The trust had launched its "Step up to Great" approach, which identified the vision and priorities for the year. Two external governance reviews had been commissioned and undertaken. One review was in response for the delivery of actions for the 2018 CQC inspection. A further review was an examination of processes and procedures within the trust for reporting investigations and learning from serious incidents requiring investigation. The trust provided newsletters, quarterly serious incidence bulletins, regular emails from matrons about incidences and lesson learnt.

However:

Some areas at Bradgate Mental Health Unit required further improvements to the environments. Response times to maintenance request were variable. Whilst there had been some improvements, the process for reporting repairs and issues varied across the wards and a time lag existed for repairs being completed.

New positions such as medicines administration assistants and link nurses to support wards were in place in certain areas, but ward staff still described irregular pharmacy visits and a lack of pharmacy oversight in medicines management.

We found evidence that patients, at the Bradgate Mental Health Unit, and in some instances, staff, smoking in ward areas. Staff told us patients were concealing lighters and cigarettes and bringing them onto wards. There were inconsistent practice around conducting searches on patients. Team meetings were not regular, or didn't take place.The sharing of lessons learnt remained inconsistent across some wards.

We looked at 20 sets of seclusion records and from 17 records, staff were not recording seclusion, in line with the Mental Health Act Code of Practice. Some seclusion rooms had environmental concerns at Belvoir and Griffin units, and Watermead wards.

The waiting list had increased for those children and young people waiting for the start of treatment, following assessment. Demand for neurodevelopment assessments remained high. The trust had long term plans to address this.

19 Nov to 23 Nov 2018

During an inspection of Long stay or rehabilitation mental health wards for working age adults

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

9 Oct to 21 Nov 2017

During a routine inspection

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

  • We rated safe, effective, responsive and well led as requires improvement and caring as good. We rated the four mental health core services as requires improvement and community health services for adults as good. In rating the trust, we took into account the previous ratings of the core services we did not inspect on this occasion.
  • We rated the trust as requires improvement for well led.
  • The environment in some services was poor, not well maintained and not kept clean. The acute mental health wards had broken facilities which had not been repaired in a timely manner and we found dirt in some areas on one ward. The environment in specialist community mental health services for children and young people, and community based mental health services for adults of working age was not suitable, did not promote safe practice and was not well maintained. The environment in the crisis service did not ensure confidentiality as rooms were not sound proofed and conversations could be heard outside the room.
  • Staffing levels did not meet requirement in some community teams. There was a high vacancy rate of 12.9% for band 5 and 6 nurses in community based mental health services for adults of working age, 18.9% for band 5 and 6 nurses in crisis service and 17.3% across community health services for adults.
  • Patients were not always safeguarded. Patients waiting for their appointment in community based mental health services for adults of working age had access to a room unsupervised which held items which could cause harm. Patients waiting for their appointment in the specialist community mental health services for children and young people used a shared waiting room with the learning disabilities adults’ services. This could pose a risk as patients were unsupervised in this area.
  • We identified medicines management issues, including out of date medication in the acute mental health wards and fridge temperatures were not monitored in community based mental health services for adults. The policy for rapid tranquillisation was not in line with national guidance.
  • Staff held high caseloads in community based mental health services for adults of working age, an issue which had been recognised by the trust and placed on the risk register. Waiting times and lists remained of concern, and this had been identified in the previous inspection. There were a high number of patients on the waiting list for treatment in the specialist community mental health services for children and young people. The waiting times in community based mental health services for adults of working age were long and breached targets. A high number of outpatient appointments were cancelled. The psychiatric outpatients was responsible for 2094 of the breaches, with city east reporting the highest of these breaches at 429.2
  • Not all patient records showed a full assessment of need, including physical health needs or up to date care plans. Care plans were not always holistic and person centred.
  • Staff were not always recording their supervision on the electronic system so we could not be assured they were receiving it regularly.
  • The acute mental health wards had two and four bedded dormitories which did not promote privacy and dignity. Patients returning from leave from the acute mental health wards were not assured of returning to their original ward. This reduced continuity of care.
  • The governance processes had not picked up the issues around repairs, medicines and cleanliness.
  • The quality of some of the data was poor. Staff could not rely on performance reports being accurate. Some local managers were keeping their own records to ensure performance was monitored.

However:

  • The trust had addressed the issues regarding the health based place of safety identified in the previous inspection.
  • The process for monitoring patients on the waiting list in specialist community mental health services for children and young people had been strengthened since the last inspection.
  • Care planning had improved in the crisis service.
  • There was an effective incident reporting process which investigated and identified lessons from incidents which were shared in most teams.
  • Patients and carers knew how to complain and complaints were investigated and lessons identified.
  • Staff were kind, caring and respectful towards patients. Most patients spoke positively about their care and said they were involved. Patients had access to advocacy.

14 - 18 November 2016

During an inspection of Wards for older people with mental health problems

We rated wards for older people with mental health problems as good because:

  • The wards complied with the Department of Health 2015 guidelines on single sex accommodation.

  • Patients reported that they felt safe.

  • The use of restraint was low and staff used it as the last resort and if verbal de-escalation had not been successful.

  • Managers had a system in place for tracking and learning from safeguarding incidents and other reportable events.

  • Managers used a tool to identify and review staff numbers in accordance with need.

  • Staff completed detailed risk assessments for patients on admission and reviewed them regularly after incidents.

  • Staff were observed to be caring and responsive to patients.

  • Staff monitored patients’ physical health regularly from the point of admission.

  • Care records were up to date and holistic.

  • There was a range of treatment and activity delivered by skilled and experienced staff.

  • Patients and carers knew how to complain.

  • Staff described managers as supportive and approachable.

  • Staffs were dedicated, passionate and patient focused.

However:

  • Managers did not ensure that staff completed Mental Capacity assessments in line with the Act.

  • On Kirby ward there was no evidence of Section 132 rights read on detention in 54% of records reviewed.

  • There was minimal evidence of patient involvement in care plans.

  • Between August 2015 and July 2016, there were 60 delayed discharges across the service.

  • There were no dedicated visiting rooms.

  • At times, there were insufficient qualified nurses on shift.

  • Clinical supervision was not taking place regularly across the service.

9 to 13 March 2015

During an inspection of Specialist community mental health services for children and young people

We rated the community mental health services for children and adolescents overall as ‘requires improvement’ because:

  • We had concerns about how environmental risks at CAMHS community sites were being assessed and managed.
  • There had been several serious incidents (SI) within this service in the last year and it was not clear that learning from investigations and actions consistently took place to prevent recurrence. For example relating to assessment of ligature points at Westcotes.
  • There had been an  increase in the number of CAMHS referrals over the last two years. This impacted on staff’s ability to assess and treat young people in a timely manner.
  • Across teams risk assessments were not always completed and updated. Some care plans had not been updated and physical healthcare checks were not routinely documented in young people’s notes.
  • There could be risks posed by the use of different recording systems across teams as staff may not all have access to all records.
  • There was a risk that staff did not receive adequate support or that their capability was not reviewed. Effective multi-disciplinary team working and joint working did not always take place across services.
  • Staff at the PIER team had not received recent Mental Health Act training.
  • The recording of discussions and assessments with people regarding consent to treatment was not always documented.
  • There was a risk that young people may not get assessed out of hours in a timely manner by staff with CAMHS experience
  • We found that there were often delays in hospital beds being identified with some people placed out of area away from their family, friends and community.

However:

  • Staff referred to having reflective practice peer meetings when they were concerned about the risk to a young person.
  • Staff received training in how to safeguard people who used the service from harm and showed us that they knew how to do this effectively. Staff knew how to report any incidents on the trust’s electronic reporting system.
  • Assessments took place using nationally recognised assessment tools and staff provided a range of therapeutic interventions in line with National Institute for Health and Care Excellence (NICE) guidelines where staffing allowed this.
  • Regular team meetings took place and staff told us that they felt supported by colleagues.
  • Most people and carers gave positive feedback about staff. Staff gave examples of working with people with diverse needs considering their ethnicity, gender, age and culture.
  • PIER staff reported having good links with universities and colleges regarding students needing early intervention services.
  • Staff described various ways in which they received information from the board and other governance meetings.

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.

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.