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Provider: Avon and Wiltshire Mental Health Partnership NHS Trust Requires improvement

Listen to an audio version of the report for Avon and Wiltshire Mental Health Partnership NHS Trust from our inspection on 04 September - 04 October 2018, which was published on 21 December 2018. Listen to the report.
We are carrying out checks on locations registered by this provider. We will publish the reports when our checks are complete.

Inspection Summary


Overall summary & rating

Requires improvement

Updated 22 May 2020

This report includes the findings from the completed service level inspections, but the well-led inspection was not completed. CQC is only able to update findings on well-led at the overall trust level or update the other trust-level ratings when we have inspected the well-led component. As a result, the ratings for the overall trust and five key questions included in this report are from a previous inspection.

Inspection areas

Safe

Requires improvement

Updated 22 May 2020

We have not updated trust-level ratings following these core service inspections because we were not able to complete the trust-level well-led inspection. This is due to suspension of routine inspections during the COVID-19 pandemic. Refer to the previous inspection report for the detailed findings on which the ratings are based.

Effective

Good

Updated 22 May 2020

We have not updated trust-level ratings following these core service inspections because we were not able to complete the trust-level well-led inspection. This is due to suspension of routine inspections during the COVID-19 pandemic. Refer to the previous inspection report for the detailed findings on which the ratings are based.

Caring

Good

Updated 22 May 2020

We have not updated trust-level ratings following these core service inspections because we were not able to complete the trust-level well-led inspection. This is due to suspension of routine inspections during the COVID-19 pandemic. Refer to the previous inspection report for the detailed findings on which the ratings are based.

Responsive

Requires improvement

Updated 22 May 2020

We have not updated trust-level ratings following these core service inspections because we were not able to complete the trust-level well-led inspection. This is due to suspension of routine inspections during the COVID-19 pandemic. Refer to the previous inspection report for the detailed findings on which the ratings are based.

Well-led

Requires improvement

Updated 22 May 2020

We have not updated trust-level ratings following these core service inspections because we were not able to complete the trust-level well-led inspection. This is due to suspension of routine inspections during the COVID-19 pandemic. Refer to the previous inspection report for the detailed findings on which the ratings are based

Checks on specific services

Forensic inpatient or secure wards

Good

Updated 10 February 2021

Community-based mental health services for adults of working age

Good

Updated 10 February 2021

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

Requires improvement

Updated 22 May 2020

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

  • Staff did not always manage risk in a way that ensured the safety of patients and staff. The service had not reduced the use of prone restraint (face down position) as identified as an improvement the trust must make following our last inspection in September 2018. The number of prone restraint incidents had increased and the percentage of all restraint incident types that involved prone position had increased from 24% to 26%. Patients had been admitted to wards out of hours despite ward staff identifying that their risks or needs could not be managed on the ward. These patients had required more restrictive interventions to manage their risks and, in two cases, had been transferred to psychiatric intensive care units, soon after admission.
  • Managers had not ensured that staff received mandatory physical health response training (PERT). Staff told us it was difficult to reserve a place on PERT courses and these were often cancelled or held outside of their locality. Training compliance with this course was below 75% across the service and 50% on Juniper ward.
  • There was not always a bed available within the trust wards for a person who would benefit from admission. Bed occupancy was generally between 95% and 100% for the previous 12 months. There had been 382 patients admitted to out of area beds due to capacity issues in the previous 12 months. The trust had identified three urgent transfer beds on Oakwood and Poppy ward which were used for patients who had been at the place of safety longer than 24 hours. Managers told us that these beds were not always used in line with the standard operating procedures and were not always reserved primarily for people from the place of safety. Staff told us they experienced increased pressure due to the quick transfer of patients into and out of the urgent transfer beds and the extra work this created from admission, assessment and risk management processes. The manager on Oakwood ward had raised these concerns with the trust and the use of these beds and impact had been added to the wards risk register.
  • Six of the nine wards we visited required environmental works to ensure they were safe and therapeutic spaces. Environmental changes were required to the layout of seclusion rooms on Elizabeth Casson House, Oakwood and Juniper ward, to ensure that patients who were high risk could safely access en-suite facilities. Some seclusion rooms also had blind spots despite the presence of CCTV. The trust had undertaken a seclusion room review and had identified these issues and particular safety risks within Juniper seclusion room. The review had concluded that work on Juniper ward should be prioritised and a further full review of seclusion rooms should be completed. The doors on Oakwood and Silverbirch ward were identified on the ward risk registers following an increase in detained patients going absent without leave (AWOL) from these wards. Silverbirch ward did not secure shut automatically and Oakwood ward’s main door opened out to the hospital grounds, and was controlled from the nursing office, therefore patients had been able to leave these wards as staff entered. Elizabeth Casson House and Oakwood ward layouts did now allow for space for female patients to access quiet and private space other than their bedrooms.

However:

  • The ward teams included or had access to the full range of specialists required to meet the needs of patients on the wards. This included, psychologists, nursing staff, medical staff and occupational therapists. Managers ensured that these staff received regular supervision and appraisal. Ward staff worked well together as a multidisciplinary team and with those outside the ward who would have a role in providing aftercare.
  • Staff completed comprehensive assessments of the physical and mental health of all patients and reviewed patient needs, and progress, regularly through multidisciplinary discussion. On Beechlydene, Sycamore, Oakwood, and Poppy wards staff developed individual care plans, which reflected the assessed needs, were personalised, holistic and recovery-oriented.
  • 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 through one to one sessions, ward reviews and care programme approach meetings,
  • Staff told us that there had been a recent improvement in engagement with staff by senior managers on design of the service and management of ongoing local risks. Staff praised their ward managers and multidisciplinary team relationships and said that morale had improved on all wards.

Wards for people with a learning disability or autism

Good

Updated 22 May 2020

  • There was a strong, visible person-centred culture. Staff treated patients with respect and built open relationships so that patients felt able to discuss their needs and raise concerns. The unit would invite families and advocates to be involved in meetings about the patients.
  • The service provided safe care. The ward environment was safe and clean. The ward had enough nurses and doctors. Managers ensured that staffing levels were adjusted to reflect the fluctuating needs of patients and the risk levels present at that time. Any potential impact of staffing vacancies was mitigated by the use of bank and agency staff familiar with the ward and its patients.
  • Staff assessed and managed risk well, followed good practice with respect to safeguarding and minimised the use of restrictive practices. Staff had the skills required to develop and implement good positive behaviour support plans to enable them to work with patients who displayed behaviour that staff found challenging.
  • Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the patients cared for in a ward for people with a learning disability and autism and engaged in clinical audits to evaluate the quality of care they provided.
  • The ward teams included or had access to the full range of specialists required to meet the needs of patients on the ward. Managers ensured that these staff received training, supervision and appraisal. The ward staff worked well together as a multidisciplinary team
  • Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
  • There were high levels of satisfaction within the staff groups. There was strong collaboration and team-working and a common focus on improving the quality and sustainability of care and people’s experiences. Quality improvement methodology was embedded on the ward. Staff were empowered to lead and deliver change.
  • The service participated in the trust’s restrictive interventions reduction programme, which met best practice standards. The service had appointed a reducing restrictive practice lead and had embedded a Positive Behaviour Support model of care, this had been effective in significantly reducing the number of restrictive interventions.
  • Governance arrangements were robust, and incidents and risks were reported, analysed and shared. Leaders had high quality management information, which showed trends and risks in the service. They were able to use this information to manage risks and improve the service.

However,

  • Medication records had a number of missing signatures and review dates. We raised this at the time of inspection and the manager agreed to follow up.

Specialist community mental health services for children and young people

Good

Updated 22 May 2020

  • The service was easy to access. Staff assessed and treated young people who required urgent care promptly and those who did not require urgent care did not wait too long to start treatment. The criteria for referral to the service did not exclude children and young people who would have benefitted from care.
  • Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment and in collaboration with families and carers.
  • Staff provided a range of care and treatment interventions suitable for the patient group and consistent with national guidance on best practice. They ensured that young people had good access to physical healthcare and supported young people to live healthier lives. The service had enough nursing and medical staff, who knew the young people and received basic training to keep young people safe from avoidable harm. Staff used recognised rating scales to assess and record severity and outcomes.
  • The teams included or had access to the full range of specialists required to meet the needs of young people. 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. Managers provided an induction programme for new staff.
  • 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 young people’ rights to them. Staff supported young people to make decisions on their care for themselves proportionate to their competence. Staff assessed and recorded consent and capacity or competence clearly for young people who might have impaired mental capacity or competence.
  • The environments were safe, clean, well-furnished and well maintained.
  • Staff assessed and managed risks to young people and themselves well and followed best practice in anticipating, de-escalating and managing challenging behaviour. Staff understood how to protect young people from abuse and the service worked well with other agencies to do so. Managers ensured that where lessons were learnt in relation to incidents, these were shared with staff.
  • Leaders had the skills, knowledge and experience to perform their roles. They had a good understanding of the services they managed and were visible in the service and approachable for young people and staff. Governance processes operated effectively at all levels and performance and risk were managed well.
  • Staff knew and understood the provider’s vision and values and how they were applied in the work of their team. Staff felt respected, supported and valued. They reported that the provider promoted equality and diversity in its day-to-day work and in providing opportunities for career progression. They felt able to raise concerns without fear of retribution.

However:

  • Not all young people found it easy to access advocacy services.
  • Not all premises were fit for purpose. Clinicians did not all have enough space in their premises to treat young people or to hold team meetings.

 

Mental health crisis services and health-based places of safety

Good

Updated 21 December 2018

Our rating of this service improved. We rated it as good because:

  • The service had taken steps to address environmental and safety concerns raised at our last inspection in June 2017. We saw that there were now safe lone working policies and staff could access personal alarms when seeing patients on site. Patient environments were assessed for risks and staff undertook checks and assessments to ensure that patients were kept safe.
  • On this inspection we found that that staff assessed patients’ mental health and risk well, updating these assessments appropriately and regularly in patient records. Staff discussed patient risk frequently in handovers, complex case review meetings and had access to supervision to help them provide high quality care.
  • Patients had access to experienced staff from a variety of mental health professional backgrounds. From observing care, speaking with patients and reviewing records, we saw that staff worked collaboratively with patients to develop care plans and meet the patient’s needs. Staff were able to offer a range of nationally recommended interventions (such as psychological therapies recommended by the National Institute for Health and Care Excellence) and had good links with local services to help meet patient’s needs.
  • Staff routinely met their targets for assessing patients in a timely way. In the health-based places of safety this ranged from 95-97% of patients being seen in 24 hours. In the intensive teams, staff saw patients within 4 hours, or within 72 hours depending on the risks of the patient. While they were with the teams, patients had access to appropriate care environments that protected their dignity and privacy appropriately. After they had left the care of the teams, staff collected patient feedback and used this to learn and improve their services.
  • Patient representatives were included in recruitment panels for new starters and managers held meetings with patient representatives to gather feedback for service developments. Staff would also meet with carers and help them receive carers assessments to meet their needs.
  • Staff teams had strong bonds and reported respecting and valuing their local leadership. They felt their managers were approachable and supportive. Staff felt able to raise concerns without reprisals.

However:

  • The North Bristol Intensive team reported that there were a number of shift were staffing levels had fallen below the minimum agreed staffing levels and had not been able to access bank or agency staff to cover these. This problem was made worse when they covered the out of hours cover for the Bristol intensive teams and meant they had to postpone visits.
  • Medicines were not managed consistently across the intensive teams. Where we found issues with how medicines were managed, staff addressed these promptly.
  • Trust policies on completing physical health checks for patients had not yet been implemented by the intensive support teams.
  • The North Bristol Intensive team did not have good access to therapy rooms on site. Staff prioritised meeting patients the patients home. Some patients would have preferred meeting staff away from their homes due for privacy reasons.

Child and adolescent mental health wards

Requires improvement

Updated 21 December 2018

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

  • Staff were unable to observe all parts of the ward due to the current layout. Staff did not routinely undertake observations of all of the ward, nor did they record when observations were carried out. Plans to mitigate ligature risks on the ward were reliant on staff being in communal areas at all times. The bannister and stair lift leading to the communal area posed a significant ligature risk and staff did not carry out observations sufficiently to ensure the safety of young people.
  • The service had not completed environmental risk assessments. During the summer, staff placed a chain across the doors leading to the garden. This did not allow enough airflow into the dining room to cool it down. Staff had not completed individual risk assessments for use of the garden area therefore there was a blanket restriction on young people having access to the garden. Risks identified in the risk assessment were not always addressed within a care plan. Not all young people had a crisis plan.
  • Although staff provided care and a range of treatments that met the young people needs, these were not reflected in the written care plans. Care plans were generic and used standard statements that did not show personalised care. Young people told us they were not involved in their care planning and that their feedback was not incorporated or listened to. Care plans were not holistic. Young people had a nursing treatment care plan however there was no evidence of input from the wider multi-disciplinary team for example occupational therapist, social worker and psychologist. Some care plans had not been updated in a timely manner in line with trust policy.
  • Staff did not receive specialist training to ensure they could meet the needs of all young people. For example, working with someone diagnosed with eating disorder or an autistic spectrum disorder.
  • Young people did not always have a discharge plan in place. In the year prior to the inspection, seven young people’s discharge had been delayed. The manager had not completed an analysis to determine causes of the delayed discharges.

However:

  • The trust had taken action the action we had required it to make at the last inspection and had ensured the fence that led from the garden directly onto the car park was now secure.
  • Staff were trained in safeguarding, knew how to make a safeguarding alert and knew how to identify young people at risk of significant harm.
  • Young people had a wide range of treatment and therapies available to them. This included a structured therapeutic programme consisting of psychological therapies, family therapy and numerous activities on and off the ward.
  • Staff interacted and engaged well with the young people. Most young people were very complimentary of the staff and the level of care available to them. For example, during the recent building work the staff organised additional activities off the ward so they could escape the disruption.
  • The service ensured that young people continued with their education when admitted and provided young people with the educational materials required for continuing with their education.
  • There was a consistent management team in place. This had improved since the last inspection. The service had implemented a management structure that included a ward manager and a service manager.

Long stay or rehabilitation mental health wards for working age adults

Good

Updated 3 October 2017

We rated long-stay rehabilitation services for adults of working age as good overall because:

  • Following our inspection in May 2016, we rated the services as good for effective, caring, responsive and well led. Since that inspection we have received no information that would cause us to re-inspect these key questions or change the ratings.

  • During this most recent inspection, we found that the trust had addressed most of the issues at Windswept ward and some of the issues at Whittucks Road that had caused us to rate safe as requires improvement following the May 2016 inspection.

  • Windswept ward and Whittucks Road had installed frosted glass between male and female wards and staff had lifted the blanket restrictions at Whittucks Road.

However:

  • Patients at Whittucks Road still had to used a shared bathroom to have a bath and had to enter into or move through a ward for the opposite sex in order to access the lift.

Wards for older people with mental health problems

Good

Updated 3 October 2017

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

  • Following our inspection in May 2016, we rated the services as good for caring but requires improvement for safe, effective, responsive and well-led. During the most recent inspection, we found that the service had addressed the majority of the issues and had made sufficient improvements.

  • The wards for older people with mental health problems were now meeting Regulations 10, 17 and 18 of the Health and Social Care Act (Regulated Activities) Regulations 2014.

  • In May 2016 the trust did not have effective alarm systems for the use of patients and staff in all wards. When we visited in June 2017, we found this had been addressed and a replacement system due to be installed on one site.

  • In May 2016 the trust were not ensuring staff received the necessary training to respond to a physical emergency. When we visited in June 2017, the majority of staff had received this training and those who had not received it had a date booked within the next two weeks.

  • In May 2016, the trust did not transfer patients to seclusion using safe or dignified methods. When we visited in June 2017, the trust had implemented a new seclusion policy to ensure the safe and dignified transfer of patients.

  • During our May 2016 inspection, there was no psychology cover for Hodson and Liddington wards. When we visited in June 2017, the wards had recruited to this post.

  • In May 2016, the trust did not ensure staff adhered to Mental Health Act (MHA) legislation and the standards described in the MHA code of practice. When we visited in June 2017, we found managers had made improvements so staff worked appropriately within the legislation.

  • In May 2016, the trust was not ensuring privacy and dignity on all the wards. Windows that looked out onto public areas did not have privacy film. When we visited in June 2017, the trust had applied opaque style window film. Also in May 2016, most of the wards for patients with dementia were not dementia friendly (where the environment is changed to help patients with dementia cope with their surroundings). When we visited in June 2017, we saw the trust had made significant improvements to ward environments and this work was ongoing.

  • During the 2016 inspection, the wards did not have good governance systems around the application and monitoring of the MHA. When we visited in June 2017, we saw improvements in this area with staff monitoring paperwork and storage and dedicated MHA administration staff.

  • All wards had access to physical health equipment and staff assessed patients on admission. Staff completed initial risk assessments on admission and ensured emergency equipment was stored safely and checked regularly. Medicines management was good across all wards.

  • Care records overall contained some detailed admission information although on some wards documentation was more thorough than on others. Staff demonstrated good examples of providing holistic ongoing care on most wards. Staff made efforts to involve patients in care planning where possible.

  • Staff prescribed medicines in line with National Institute for Health and Care Excellence (NICE) guidelines. They followed best practice to avoid using antipsychotic medicine where possible.

  • All wards held multidisciplinary meetings to discuss complex patient needs, discharge planning, Care Programme Approach reviews and risk management. We observed some robust and good quality discussions between the wards and partner agencies.

  • We observed kind, discreet and respectful interactions by staff towards patients. Feedback from patients and carers was highly positive across the wards.

  • The trust monitored admissions and readmissions carefully. Managers escalated delayed discharges to senior trust staff that monitored inpatient capacity through the corporate risk register.

  • Ward managers were visible on the wards and had made improvements to their areas of responsibility since the 2016 inspection. Staff described them as approachable and hands-on and staff reported good morale on the majority of the wards.

However:

  • Although they had partially addressed the risk issues identified in May 2016 around ligatures, The service still did not fully meet regulation 12 of the Health and Social Care Act (Regulated Activities) Regulations 2014 in this and some other areas.

  • Staff did not always clearly document how they were managing initial or ongoing risks. There was not always a clear path from the initial risk assessment to the planning of care. Documentation of risk was disjointed and not well communicated in places, such as handover or the daily records, which meant risks could be overlooked.

  • Ward 4 in Bath had dormitory style shared accommodation. This increased risks to patients particularly at night. This was a dementia ward with some complex, confused and sometimes aggressive individuals and the staff could not guarantee optimum levels of safety as compared to individual bedrooms.

  • Aspen ward had blind spots that staff could not mitigate well particularly at night and had no convex mirrors in place to aid this. This area of the corridor had handrails that the trust had not adapted or boxed in to reduce risk. Patients were in the garden area unsupervised during our inspection when we were told they should be monitored.

  • The trust had addressed the issue of privacy and dignity on wards with bedroom windows looking out on public areas.

  • There were too many generic care plans that lacked individualisation across all the wards. Occupational therapy (OT) and psychology cover was sparse on Cove and Dune wards. Staff did not consistently use health of the nation outcome scales in order to effectively measure outcomes.

  • Dune ward was still awaiting improvements to the environment. The flooring was problematic for the patient group, as it was multi-tonal and shiny, potentially increasing visual perception problems and confusion in this client group. Ward clocks were too high for patients to see clearly.

  • Not all managers had completed root cause analysis (RCA) training in order to investigate incidents.

Community mental health services with learning disabilities or autism

Good

Updated 8 September 2016

We gave an overall rating for community mental health services for people with learning disabilities or autism of good because:

  • The services conducted assessments, including specialised risk assessments, at the appropriate time. Teams considered physical health needs and monitored them. Care plans were patient focused and staff were respectful of people using the service. Information was available in an accessible format and there was a patients forum that inputted in to the service that people could attend.

  • There were good staffing levels and caseloads were appropriate. There was clear eligibility criteria and a referral pathways.

  • The services regularly reviewed their practice; we saw evidence of learning from incidents, including changes in working practices. The intensive support team was reviewing their operating policy and referral procedure to ensure it met the needs of the people accessing the service. The forensic team had developed interventions from an evidence base, which met the identified needs of the people accessing the service.

However:

  • The intensive support teams electronic record system did not have active risk assessments or contain all the required risk information. There was no effective procedure in place to mitigate this. Not all intensive support team care plans were uploaded on the electronic record system. Some people using the forensic service had not received their care plan in a timely fashion.

  • Services did not have a full range of mental health professions in their teams.

  • There were no recognised outcome measures in place and staff did not routinely give people information on how to make a complaint.

Community-based mental health services for older people

Good

Updated 8 September 2016

We rated community-based mental health services for older people as good because:

  • Staff demonstrated an awareness of risk. The majority of care records contained an appropriate and up to date risk assessment. Staff had safe lone working arrangements. Staff had an understanding about how to report incidents. Staff felt confident in raising concerns and knew how to escalate them if necessary.

  • The teams included a full range of specialist allied health professionals to provide effective assessment and treatment. The staff in the teams worked well with other local services and with the other older adult services provided by the trust in their locality.

  • Patients and carers that we spoke with reported that the staff were kind and caring. They said they felt included in their care and we saw that this was clearly documented in almost all of the care records we reviewed.

  • Staff reported that management within the locality were approachable. They said that morale was generally good and that things had improved in recent years.

However:

  • Some teams (North Somerset later life therapies and Swindon memory service) were not meeting the trust’s targets for assessment.

  • In the North Somerset teams, although there were alarms available for staff to use, there was no record to show these had been routinely checked.
  • While local management was approachable and involved, staff reported that the senior management team based at trust headquarters were not as visible.

Substance misuse services

Good

Updated 8 September 2016

We rated Avon and Wiltshire Mental Health Partnership Trust’s substance misuse services as Good because:

  • Staff were following ‘Drug misuse and dependence: UK guidelines of clinical management (2007) and National Institute for Health and Care Excellence (NICE)’ guidelines for substitute prescribing and psychological therapy, which also informed trust policies and procedures.

  • Staff monitored clients in the community safely and regularly throughout the treatment period. Medical cover was available over a 24 hour period and there were emergency procedures in place.

  • Staff completed and updated risk assessments. They had a clear understanding of individual risks and were highly skilled and experienced. Risks were managed well both in community and inpatient settings. Recovery care plans involved the client and were clear and holistic and contained detailed information regarding client’s care and treatment..

  • Environments, including clinic rooms, were clean and well maintained and laid out in a way which protected privacy. Information was freely available specific to substance misuse problems. For example other agencies, social services and advocacy.

  • Medicines management was effective throughout the services. Where medicines were kept on site they were stored, monitored and audited safely.

  • There were sufficient staff numbers to meet the needs of people using the services. The community specialist substance misuse services (SDAS) had reduced their staffing numbers when they redesigned their service models. Managers had worked creatively to ensure client safety through the redesign of the service.

  • Community SDAS and inpatient services provided support for all healthcare needs associated with substance misuse. Staff supported people with blood-borne virus testing. Electrocardiograms were taken for people receiving high doses of methadone to monitor the effects on the heart. Some services provided specialist input into general practitioner (GP) surgeries, which was considered by GP’s as a highly effective service.

  • Staff were very caring and demonstrated a high level of positive regard and respect to people accessing the services. Staff attitudes towards people were warm, kind, non-judgemental and thoughtful.

  • The services were managed by highly committed and inspirational leaders. They demonstrated a clear determination to ensure that needs and safety were not affected by the redesigns and upcoming retendering processes. For example, Avon and Wiltshire Mental Health Partnership Trust provided the South Gloucestershire service. However in the near future other health organisations would have to opportunity to bid to manage this service instead. Staff told us they felt supported, supervised and positive about their place within the teams.

  • The trust gave staff opportunities to develop leadership and specialist skills across the different roles within the service. Poor performance issues were managed well.

However:

  • Although we saw that risks were discussed, reviewed and updated on Acer Unit, locating where updated risk assessments was difficult in patient records. There was no clear system in place.

  • The redesign of the Bristol recovery orientated alcohol and drugs service specialist drug and alcohol service (Stokes Croft) had resulted in pressure and a backlog within the rapid prescribing service. This team was holding high caseloads as they waited to transfer clients to their Colston Fort specialist drug and alcohol service.

Adult solid tumours

Updated 18 September 2014

Avon and Wiltshire Mental Health Partnership NHS Trust provides community-based mental health care, treatment and support to people, their friend’s families and carers. It offers people a range of treatments (psychological and medication, support and advice.

Although, we found that services generally managed risks well, we found that two of the teams did not monitor or store medicines, or dispose of unwanted medicines, in a safe manner.

We concluded that people received effective care and treatment by hard working, caring and competent staff who received regular clinical supervision. Most patients that we talked to told us that staff treated them with dignity and respect and whenever possible, staff supported people who used services to manage their own health and care needs to maintain their independence.

The care plans that we reviewed suggested that care was planned and delivered in a way that took into account the wishes of the person. However, some of the care plans reviewed lacked detail and there was no evidence that people’s rights were explained to them under their ‘community treatment order’ (CTO). There was also limited evidence that, where needed, people’s care plans were linked to their community treatment orders. We brought this to the attention of senior staff during the inspection.

The work of the community mental health teams was affected by the unavailability of admission beds.  This meant that some people were being accommodated in hospital beds that were a long distance away from their home. It also meant that there were, on occasion, delays in accessing a bed. Throughout the services we visited, however, we did find good working arrangements with primary care and third sector providers.

We saw good examples of local leadership in all of the services we visited. Most staff were aware of the trust’s vision, values and strategies, and of its local management structure. However, other staff felt undervalued by the trust. There was an ‘Information Quality’ (IQ) system in place, which enabled senior managers to regularly review the service’s quality and records management, with findings disseminated to the teams. We saw that this was being effectively used by senior managers.

Reference: NA not found

Updated 18 September 2014

The specialist services of Avon and Wiltshire Mental Health NHS Trust provide care and support for adults at a range of locations across the trust catchment area. Services include: New Horizons mother and baby unit; STEPS eating disorder unit; a drug and alcohol detoxification unit and  community services for the deaf, and those with ADHD and autistic spectrum disorders.

We found areas of good practice and many positive interventions in all the teams we inspected. In particular, we found that the inpatient eating disorder unit and the community teams were delivering very good specialist intervention work.