Avon and Wiltshire Mental Health Partnership NHS Trust

Ratings - Well-led

• Well-led Our assessments of NHS trusts now focus on leadership. We no longer rate trusts overall for their safety, effectiveness and responsiveness or how caring they are. We do still publish those ratings for the services they provide.

  Requires improvement

Our view of the service

Date of assessment: 16 July to 8 August 2024. Avon and Wiltshire Mental Health Partnership NHS Trust provides Mental Health services across a catchment area covering Bath and North East Somerset, Bristol, North Somerset, South Gloucestershire, Swindon and Wiltshire. Avon and Wiltshire Mental Health Partnership NHS Trust serves 2 Integrated Care Boards and 6 local authorities; NHS England also commission specialist services. The trust employs over 5,000 substantive staff. It operates from over 90 sites including 8 main inpatient sites and services are delivered by 150 teams across a geographical region of 2,200 square miles, to a population of approximately 1.8 million people. The trust has a total of 21 locations registered with CQC.

The trust sits within two Integrated Care Systems (ICS). These are:

• Bristol, South Gloucestershire and North Somerset (BNSSG)

• Bath and North East Somerset, Swindon and Wiltshire (BSW).

We carried out a well led assessment of the trust which commenced with a 3-day site visit on 15, 16 and 17 July 2024. This assessment was due to concerns over the previous 12 months about the quality of care across various services. Before carrying out this well led assessment, we carried out assessments of Acute and Psychiatric Intensive Care Unit services and Community Mental Health services for people of working age to check how well the overall trust strategy and risk management aligns with local services.

During the Well led assessment, we identified breaches of the legal regulations relating to safeguarding and good governance. This was because the trust had not ensured leaders consistently and fully engaged with system partners on strategic issues. They had not ensured, Freedom to Speak Up processes were effective, that racism and discrimination were addressed across all services and safeguarding systems and processes were effective.

People's experience of this service

Patients and carers told us the trust had mechanisms to hear their feedback. However, felt the trust had been slow to implement actions to drive improvements. Patient representatives told us they felt the trust involved them to provide feedback after key decisions had been made rather than as part of the decision-making process. Some people felt they were involved because the trust needed to involve them rather than as a genuine desire to hear the voice of patients. They told us the trust needed to improve on co-production and designing services that suited their needs. People felt there needed to be better patient representation at board level so there was a better understanding of patients’ needs. External stakeholders told us trust responses to issues could be variable and have historically been slow. The trust did not always ensure there was representation at key meetings by the executive team. This impacted on the timeliness of decisions being made. However, it had been noted responses to issues were improving slowly.