Southern Health NHS Foundation Trust

Updated 21 April 2023

We carried out an unannounced comprehensive inspection of six of the mental health services provided by Southern Health NHS Foundation Trust as part of our continual checks on the safety and quality of healthcare services.

Following this inspection, we rated the trust ‘requires improvement’ overall. In addition, we rated each of the key questions – safe and effective as requires improvement and caring, responsive and well led as good overall. The rating of safe had reduced from good to requires improvement.

During this inspection we inspected six of the Trust’s core services and rated two as good (wards for people with a learning disability or autism, child and adolescent mental health wards) and four as requires improvement (forensic inpatient/secure wards, wards for older people with mental health problems, crisis services and health based places of safety and acute wards for working age adults and psychiatric intensive care units).

The rating for acute wards for working age adults and psychiatric intensive care units and forensic inpatient/secure wards had reduced from good to requires improvement. The rating for mental health crisis services and health-based places of safety and wards for older people with mental health problems remained requires improvement. Additionally, wards for people with a learning disability and autism had reduced to good from outstanding.

We also undertook an inspection of how ‘well-led’ the trust was, and we rated this good. Southern Health NHS Foundation Trust is one of the largest providers of mental health, specialist mental health, learning disabilities and community health services in the UK with an annual income of approximately £316 million. The trust provides these services across Hampshire. It employs 5,927 staff who work from over 200 sites, including community hospitals, health centres and inpatient units as well as delivering care in the community. The trust has 634 inpatient beds. The trust received foundation status in April 2009 under the name Hampshire Partnership NHS Foundation Trust. Southern Health NHS Foundation Trust was formed on 1 April 2011 following the merger of Hampshire Partnership NHS Foundation Trust and Hampshire Community Healthcare NHS Trust. The trust has a well-publicised history of challenges and regulatory action, culminating in successful prosecutions by CQC and the Health and Safety Executive. The trust has taken action to address the issues that resulted in the prosecutions and have used these to learn and improve the services.

Southern Health NHS Foundation Trust provides community health, mental health and specialist mental health and learning disability services for people across the south of England. Covering Hampshire, the trust is one of the largest providers of these types of services in the UK.

Our last comprehensive inspection of the core services was in October 2019 when we inspected four mental health core services.

At our last inspection we rated the trust as good overall.

The core services inspected on this occasion were chosen due to intelligence that we held, with a decision to inspect made on the balance of risk to service users. This included consideration of the previous inspection and ratings.

The trust provides ten mental health core services

• Acute wards for adults of working age and psychiatric intensive care units (PICU's)
• Long stay/rehabilitation mental health wards for working age adults
• Forensic inpatient / secure wards
• Child and adolescent mental health wards
• Wards for older people with mental health problems
• Wards for people with a learning disability or autism
• Community-based mental health services for adults of working age
• Mental health crisis services and health-based places of safety
• Community-based mental health services for older people
• Community mental health services for people with a learning disability or autism

The trust also provides two specialist mental health services

• Perinatal service
• Eating disorder service

The trust provides five community health core services:

• Community health services for adults
• Community health services for children, young people and families
• Community health inpatient services
• End of life care
• Urgent care

On this inspection we inspected six mental health core services:

• Acute wards for adults of working age and psychiatric intensive care units (PICU's)
• Child and adolescent mental health wards
• Forensic secure wards
• Wards for older people with mental health problems
• Wards for people with a learning disability or autism
• Mental health crisis services and health-based places of safety

Experts by experience (people who have experience of using services or caring for those who use services) and specialist advisors (senior practitioners with specialist knowledge and experience of working in the core services areas) were part of the inspection teams for each core service inspection and so helped us collect high quality evidence and make robust judgements.

We also looked at how well-led the trust was. In order to ensure we have appropriate expertise to make a robust judgement about how well-led the trust is, our inspection team comprised an executive reviewer (a board level leader from another organisation rated good or outstanding), a specialist advisor with expertise in governance and a senior leader from NHSI/E with financial expertise as well as CQC inspection team members.

Our rating of services went down. We rated them as requires improvement because:

We rated two of the key questions, ‘are services safe and effective’ as requires improvement. We rated three of the key questions, 'are services caring and responsive and well led' as good.

We rated two of the trust’s mental health services as good and four as requires improvement. In rating the trust, we considered the current ratings of the nine services we did not inspect this time which have retained the previous ratings.

We had serious concerns about the safety on one of the wards for older people with mental health problems. As a result of the significant concerns identified, we wrote to the trust to seek immediate assurances about the safety of the service. We advised them that if there was not significant improvement in the safety of care on the ward, we would take enforcement action to address the issues. The trust responded by reducing the bed numbers, improving the staffing ratio, reviewing risks and practices around safeguarding and falls. The trust submitted an action plan to CQC to demonstrate how the changes were to be implemented and embedded going forward. Following two further visits to the ward, the inspection team were satisfied that immediate risks to patient safety had been addressed to prevent immediate and significant enforcement action being taken. Leaders at all levels were not cited on and did not recognise the seriousness of the issues on Beaulieu Ward and the significant safeguarding concerns found in incidents were not picked up and acted upon.

The trust had difficulty attracting substantive staff. Staffing levels were not always being met. We identified concerns relating to staffing levels in four of the six services we inspected. Staff told us there were not always enough staff to effectively manage higher acuity patients at Ravenswood House Medium Secure Unit, leaving them and patients unsupported. The crisis service at Parklands reported a high vacancy rate and had an over reliance on the use of agency staff and staff on the older persons and acute and PICU wards did not always have enough staff to keep patients safe. Staff on the acute and PICU wards told us that this meant they were not always able to provide the level of care to patients that the patient should expect. This included less leave and less time in therapy focused work.

Some staff in mental health services felt unsafe due to an increase in the acuity of illness of the people they were caring for and incidents of violence against staff. Staff told us that the number of injuries to staff and patients during incidents of aggression on the acute and PICU wards were increasing and they did not always respond to changes in risk. Staff felt pressured to admit patients onto wards when it was unsafe.

There were pockets of low morale across the trust, this was impacted by staffing pressures.

In three of the services inspected, we found gaps in the recording of National Early Warning Score 2 (NEWS2) records we reviewed. This included missed entries, missed signatures and totals not completed. In the absence of these records where a patient’s deteriorating health should have been escalated in line with national guidance, this could have been missed and not escalated.

Several strategies had been put on hold during the COVID-19 pandemic and there was work to do to bring the clinical strategy and the wider trust strategy together into a comprehensive document that set out the direction clearly. There was a clear vision that was understood and articulated by a number of the senior leadership team around working in partnership and collaboration to deliver good quality services to meet the health needs of the local population – although there was a need to ensure this and what it meant is communicated effectively to a wider audience.

However:

One of the biggest risks in the organisation was staffing in the mental health inpatient wards, the trust had plans in place regarding recruitment and the board recognised this was an area which needed to be achieved at pace.

Staff were proud to work for the trust. There was a strong sense of staff at all levels putting patients at the heart of everything they do. All staff were respectful, compassionate and kind towards patients. Staff were also friendly, approachable and supportive. We saw positive interactions between staff and patients. Staff were highly motivated and provided care in a way that promoted patient’s dignity.

The trust leadership was now stable and capable. Since the last inspection the board had appointed a new chief executive and a new medical director. Two new non-executive directors (NEDs) also joined the trust during the pandemic.

The trust had a Board Assurance Framework and a risk register which were regularly reviewed. The performance team delivered good quality reports for each division to have an overview of risk within the divisions.

We found that the trust now had a highly skilled, strong, stable and experienced senior team, including the chair and non-executive directors. Leaders had the skills, knowledge, integrity and experience to perform their roles and had a good understanding of the services they were responsible for delivering. They were visible in the service and approachable to patients and staff.

There was a strong estate’s, workforce, digital and safeguarding team, medical and financial leadership. Nursing and AHP leadership were strong and the team communicated well and knew the issues they faced and were clear about how they would address them. There was strong leadership of the Council of Governors with a clear view on working in partnership whilst challenging the board to ensure safe and effective service delivery on behalf of the public.

We met individuals and teams who were very proud of working at the trust; with lots of hope for the future. The trust was building on the past and getting to grips with the job of taking the organisation forward. The trust was coming through legacy issues and learning from these, building. Everyone we met spoke positively.

People accessing the learning disability ward were receiving safe and effective care. They were treated with dignity; risks were assessed, and the environment was safe. They received kind and compassionate care.

The trust engaged well with patients, staff, equality groups, the public and local organisations. Trade union representatives were very positive about how the trust leaders worked with them in an open and transparent way and had supported staff throughout the pandemic.

The trust had reviewed their disciplinary policy and made changes based on a Compassionate and Just Culture model.

There was good practice and innovation around IT and the digital focus. Digital development and information governance systems were strong with consistent clinical and service line engagement.

Learning from serious incidents had been strengthened and the trust had been rewarded accreditation through the Royal College of Psychiatrists’ Serious Incident Review Accreditation Network (SIRAN). The trust used ‘favourable event reporting’ where they learned from things that had gone well in the same way they learned from things that had not gone so well. The aim was to replicate good practice and disseminate this across the trust. The trust had responded to serious incidents and investigated them. Following the inspection, a serious incident occurred at Parkland’s hospital that resulted in the death of a patient. The trust had commissioned an independent investigation into this and worked closely with the police.

How we carried out the inspection

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

We used CQC’s interim methodology for monitoring services during the COVID-19 pandemic including on site and remote interviews by phone or online.

For the child and adolescent mental health wards inspection, the inspection team:

• visited all three sites, looked at the quality of all the ward environments and observed how staff were caring for patients,
• spoke with 14 young people who used the service and six family members,
• looked at 21 electronic and paper copies of care and treatment records,
• observed an assessment and admission meeting, a shift handover meeting, a daily team meeting and two ward round meetings,
• spoke with 35 staff including a head of nursing, a head of operations, three modern matrons and three ward managers. We also spoke to members of the multidisciplinary team, social workers and a pharmacy technician,
• reviewed a range of documents relating to the running of the service,
• looked at medicine’s management, including medicine charts.

For the adults of working age and psychiatric intensive care unit’s inspection, the inspection team:

• visited eight wards at the three sites and looked at the quality of the ward environment and observed how staff were caring for patients
• spoke with 22 patients who were using the service both in person and via telephone calls.
• spoke with five carers
• spoke with the ward managers or interim managers for each ward
• spoke with 37 other staff members; including doctors, nurses, occupational therapist, occupational therapy assistants, healthcare assistants, social workers, pharmacy technicians and a psychologist
• attended and observed multi-disciplinary meetings and safety huddles
• looked at 21 care and treatment records of patients
• carried out a specific check of the medicine management on all wards; and
• looked at a range of policies, procedures and other documents relating to the running of the service

For the wards for people with a learning disability or autism inspection, the inspection team:

• visited Ashford and looked at the quality of the environment and observed how staff were caring for people
• spoke with head of operation and modern matron
• interviewed the ward manager
• checked the clinic room
• spoke with eight patients
• spoke with five staff including nursing staff, support workers and positive care and safety coordinator
• spoke with the forensic psychologist, occupational therapist, social worker
• reviewed five care records and 10 treatment records
• reviewed several meetings minutes and looked at a range of policies and procedures related to the running of the service

For the wards for older people with mental health problems inspection, the inspection team:

• visited four wards
• interviewed the four ward managers
• checked the clinic rooms and reviewed the medicine charts
• spoke with 17 patients
• spoke with five carers or relatives of patients
• spoke with 26 staff including doctors, nurses, occupational therapist, occupational therapy assistants, healthcare assistants, social workers
• reviewed 33 care and treatment records of patients
• reviewed several policies, meetings minutes, personnel records and supervision records
• observed staff meetings on the wards, including multidisciplinary team meetings, ward rounds, staff handover meetings, patient safety at a glance (PSAG) meetings

For the forensic inpatient/secure services inspection, the inspection team:

• visited six wards at the two sites and looked at the quality of the ward environment and observed how staff were caring for patients
• spoke with 16 patients who were using the service both in person and via telephone calls.
• spoke with 3 carers
• spoke with five ward managers
• spoke to the modern matrons of the two sites
• spoke to 3 consultant psychiatrists and 5 junior doctors
• spoke with 28 other staff members; including a psychologist, an occupational therapist, a pharmacy lead, two pharmacist technicians, a social worker, nurses, health care assistants, a ward administrator and student nurse.
• attended and observed one handover meeting, a morning planning meeting, a Situation Report (sitrep) meeting and multidisciplinary care review meetings for three patients
• looked at 32 treatment records of patients
• reviewed 34 medicine prescription charts
• reviewed eight staff records
• looked at a range of policies, procedures and other documents relating to the running of the service.

For the mental health crisis and health-based place of safety inspection, the inspection team:

• Visited the crisis teams, also known the home treatment teams within Parklands and Antelope House. These teams are recognised within the Trust as Crisis Resolution and Home Treatment teams (CRHT).
• Visited the crisis team at Elmleigh, who acknowledge and process referrals, provide face to face assessments of patients before the case is handed over to the home treatment teams located in other areas of the region.
• Visited the Parklands health-based place of safety (HBPoS), the HBPoS at Antelope House and Elmleigh were being used during the time of our visits.
• Reviewed 11 care and treatment records of patients using the HBPoS.
• Reviewed nine care and treatment records of patients across the crisis and home treatment teams.
• Attended two multi-disciplinary team meetings.
• Spoke to 22 staff members; including clinical team leaders for the home treatment team and health-based place of safety, qualified nurses, service managers, healthcare assistants, consultant psychiatrists, operational director, patient flow manager.
• Looked at a range of policies, procedures and other documents relating to the running of the service.
• Spoke with one patient who had used the health-based place of safety, and five patients who had been supported by the home treatment team.
• Spoke with one family member of a patient.

What people who use the service say

On the older persons ward except for one patient, all patients who were able to talk to us said they were happy with their care and positive about their experience. Patients were able to say the activities were good and there was a good choice of food. Patients said that staff took time to listen to them and staff are very caring. Patients said they knew who their named nurse was, and they could speak to them if they had a problem.

Within the crisis service patients told us staff were respectful and kind. Patients and their carers told us that staff were caring and supportive.

Within CAMHS, young people were largely positive about their experiences at the service. The young people we spoke with reported feeling safe and felt that the staff were kind and respectful and took a genuine interest in their care and wellbeing. Young people told us that they had the opportunity to maintain contact with their families, were involved in care and discharge planning and had copies of their care plans. Young people said that food was generally good, and they particularly enjoyed some BBQs during the pandemic. They also told us that they had access to doctors when needed.

We received mixed information from young people regarding activities. Whilst some young people in Austen House told us that activities were not cancelled and they had two activity coordinators, young people at Bluebird House told us that they were bored during weekends and there was not enough staff. Young people at Leigh House told us that there were issues with staff shortages and as a result walks were cancelled.

Some young people and relatives at Leigh House told us that they were unhappy that sometimes male staff were carrying out observations of young females. Some young people at Austen House raised some issues with us which we followed with staff and received explanations.

We also received positive feedback from the families we spoke with about the quality of care young people received from staff. Most of the relatives we spoke with felt that young people were safe and that visiting arrangements were good. Some relatives told us that that they participated in ward round meetings, kept informed and received ward round notes. However, some relatives were concerned about staff shortages and the arrangements for contact with families as sometimes they received too many calls in one day.

At Ashford people told us the staff were very kind, supportive and helped them to understand information. They praised the staff and said they were helpful and understood their needs. Although people said the ward was short staff at times, they gained attention from staff when they needed to discuss their needs and how they were going to be supported.

On the Acute and PICU wards most of the feedback we received from patients and carers was positive. Patients told us that staff were polite and respectful and that they felt safe on the wards. Patients also told us that there were enough activities and regular leave. However, they also told us that the wards were often short staffed and that leave, and activities were sometimes cancelled because of this. Patients also said that that if there were incidents on the ward they did not feel as safe. Patients told us this was because the staff had to manage the incident.

The carers we spoke to told us that staff cared for their family member or friend and treated them well. Staff involved carers in the patients care. However, they also told us it was difficult to contact the ward at times and the quality of the information you received depended on who answered the phone.

Within the forensic ward’s patients said staff treated them well and behaved kindly. Fourteen of the patients we spoke with told us staff were approachable and very supportive. However, they also commented that the quality for the food could be improved.

Updated 3 October 2018

• Sufficient numbers of suitably trained staff were deployed to meet patients’ needs. Further training opportunities were provided by the trust to allow staff to expand their skills and professional knowledge.

• Staff followed professional guidance and applied this in their treatment to provide safe and effective care to patients.

• Patients received outstanding care delivered by staff who took exceptional care to ensure their emotional and wellbeing needs were met.

• Staff recognised and acknowledged patients who had additional support needs associated with their illness or long-term health condition. Patients were supported by staff who understood how to meet these additional needs.

• The trust was led by a strong executive team who demonstrated a visible presence to staff. Staff spoke positively of the service leadership saying they promoted a patient centred culture which was focused on improving the lives of the patients they supported.

However:

• One team did not have access to the trust’s ‘Store and Forward’ record keeping system on their laptops. This meant not all patients had up to date information available in their homes for other health and social care professionals to follow.

• The investigation of complaints did not take place in a timely way leading to delays in responding to the complainant. The service did not complete investigation of, respond to, and close complaints within agreed timescales.

Updated 3 October 2018

• There were sufficient numbers of skilled staff to deliver the service and staff had regular appraisals and training.
• Staff completed and updated records of people’s care and treatment, and delivered care based on best practice guidance.
• The service had systems for reporting incidents, complaints and risks and staff used these to improve care and practices.
• Staff showed kindness and compassion and were committed to providing a good service to children, young people and families in the community.
• There was an effective leadership and governance structure and a positive culture within the service. Staff understood the service aims, priorities and performances.
• Staff understood the needs of the families in the local areas where they worked. They monitored non-attendance at appointments and acted to engage people who might to vulnerable.

Updated 3 October 2018

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

• Staff across all sites followed professional guidance and applied this in their treatment to provide safe and effective care to patients.
• The trust was taking action to recruit and retain staff to ensure sufficient numbers of suitably trained staff were either employed or about to start at the trust to meet patients’ needs. There were effective selection, deployment and support processes in place along with succession planning.
• Staff had completed training and were knowledgeable about responding to and treating risk. There were effective handovers at shift changes and safety briefings to ensure that staff could manage risks to people who used the services.
• Safeguarding adults, children and young people at risk was given sufficient priority.
• People’s care and treatment was planned, delivered and monitored in line with current evidence-based guidance, standards, best practice, legislation and technologies. People had assessments of their needs, which included pain relief, mental health, physical health and wellbeing, and nutrition and hydration needs.
• Expected outcomes were identified and care and treatment reviewed and updated. Appropriate referral pathways were in place to make sure patients’ needs were addressed. The service monitored the effectiveness of care and treatment and used the findings to improve.
• Staff were consistent and proactive in supporting people to live healthier lives. There was a focus on early identification and prevention and on supporting people to improve their health and wellbeing.
• The leadership, governance and culture promoted the delivery of high-quality person-centred care.

However:

• At Romsey hospital the geography of the wards did not facilitate the delivery of safe care and treatment at night time.
• At Romsey hospital the privacy and dignity of patients was not always maintained as bed spaces were less than the recommended guidelines.
• Safe records management was not consistent across all the hospitals. In some ward areas at Lymington hospital records were stored in an unlockable drawer.
• Medicines management was not always provided safely. In some areas medicines were not stored safely in line with the manufactures guidelines and in some cases reused which was not in line with hospital policy

Updated 3 October 2018

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

• Staff providing end of life and palliative care were appropriately trained and understood their responsibilities to keep people safe and what to do if they needed to raise a concern. There was improved oversight of end of life training and competencies.
• Caseloads in the specialist palliative care team were planned and reviewed to ensure people received safe care and treatment at all times.
• Risk assessments for care and treatment were used for patients receiving end of life and palliative care. There was timely access to advice, initial assessment care and treatment and, diagnosis or urgent treatment. Advice could be accessed at different times of the day.
• Staff prioritised care for vulnerable patients with the most urgent care needs.
• All wards and buildings we inspected were visibly clean. Staff followed infection prevention and control procedures and routine standards of cleanliness and hygiene were maintained.
• The trust had improved the quality of patient records since the last inspection in 2017 to ensure information was included in a person centred manner.
• There was a positive reporting culture within the trust, themes from patient safety incidents were identified monthly through the patient safety group and quality and safety committee.
• Policies and procedures were developed in line with national guidance, and were accessible to staff to support their practice. The trust had recently commenced The National Audit of Care at the End of Life a three-year internal audit, specific to end of life and palliative care.
• Improvements had been made in the use of individualised end of life care plans since our previous inspection and there were systems to record patients preferred place of death and to monitor outcomes.
• Staff worked together to deliver effective care and treatment through multi-disciplinary teams.
• Patients and those close to them told us they were treated with kindness, dignity and respect while they received care and treatment including during physical or intimate care. We saw staff show an encouraging, sensitive and supportive attitude to patients and those close to them who used the services.
• Staff communicated clearly and knowledgably with patients so that they understood their care, treatment and condition.
• Staff ensured that when a person was in the last days and hours of life they had an individual plan of care, which included food and drink and symptom control.
• The trust worked with several clinical commissioning groups to understand and plan end of life and palliative care.
• Some community hospitals had side rooms that could be used when available for patients at end of life such as Anstey ward at Alton community hospital.
• The trust had an interpreter system and sign language specialists available. All community hospital wards had ‘dementia link’ nurses and had undertaken dementia awareness training.
• Wherever possible, the trust ensured the same nurses visited the same patients to provide continuity of care to enable easier identification of changes in a patient’s wellbeing.
• People who used the service knew how to make a complaint or raise concerns, and they were encouraged to do so.
• The leadership and culture of staff reflected the vision and values of the organisation. The trust had a vision to provide high quality, safe end of life care. The governance framework was clear. Quality, performance and risk was, managed and leaders could identify the actions needed to address challenges to quality care.
• The strategy was aligned to the National Palliative and End of Life Partnership’s Ambitions for palliative and end of life care and the values of the trust.
• Services had continuously improved since the last inspection. The trust had reviewed progress of the implementation of the four-year end of life strategy (2017).
• Staff felt respected and measures were taken to ensure staff were safe when lone working. Staff received support after working in distressing situations.
• Leaders we spoke with at all levels of the organisation described staff as passionate about end of life care and said staff provided high levels of care.
• Leaders prioritised the participation and involvement of most staff. Staff views and experiences were gathered by a series of ‘your voice’ staff engagement events.

However:

• When we reviewed seven sets of records we saw that do not attempt cardio pulmonary resuscitation or DNACPR decisions were still not always recorded appropriately and in line with national guidance.
• A number of improvements were still required for the recording of patient information in patient records, particularly related to timings of entries and level of detail in medical notes and clear rationale for prescribing decision.
• At May 2018 there were three community teams still below the 60% target set for syringe driver training and competence.
• Complaints received by the trust were not routinely able to be recorded under end of life care. The introduction to the electronic system for incidents of a means to do so was under review.
• The availability of information for patients and those close to them had been the subject of a thematic review which identified improvements were required in this area.
• There was no non-executive director lead for end of life and palliative care and the roles of leaders for end of life care were not clear from the intranet.
• Not all relevant staff felt engaged in creating the strategy for end of life care.
• The trust did not have a mechanism to explicitly gather experiences and opinions from those who had experienced the trust’s end of life care provision.
• The trust did not participate in the Gold Standards Framework (GSF) Accreditation process.

Updated 3 October 2018

• Patients at both MIUs were seen quickly, assessed, treated and discharged within the national set target of 4 hours.
• The service had enough staff with the right qualifications and experience to keep patients safe from avoidable harm and abuse and to provide the right care and treatment.
• Staff treated patients and those close to them with dignity and respect. Patients felt supported and provided positive feedback.
• Staff responded compassionately to pain, discomfort and emotional distress in a timely and appropriate way.
• The trust board had determined and kept under review the information it required to monitor performance, set priorities and make decisions through a local reporting system.
• Safety was a priority at all levels. Staff took an active role in delivering and promoting safety, learning and improvement.
• Safety performance included waiting times for assessment and treatment, adverse incidents, complaints and compliments, which were monitored continuously and were reported to the board. We reviewed safety data from April 2017 to March 2018 and found no serious issues.
• There was a positive culture and a very good supportive team working amongst staff. Staff at both MIU spoke enthusiastically about their department and the support they received.

However:

• The Petersfield MIU was small with two clinical areas and was not fit for purpose due to the workload and this had been acknowledged by the trust. There were plans in place to reconfigure the area to increase to five clinical spaces. The present arrangements did not breech the privacy or dignity of patients.

Updated 10 February 2022

Updated 3 October 2018

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

• Staff were caring, respectful and compassionate. Patients and carers gave consistently positive feedback about staff. Staff understood patients’ needs and preferences and found creative ways to communicate with patients and involve them in their care.
• Carers felt supported by the staff teams and felt staff helped them solve problems and were available for additional support. An intensive support team created tailored care programmes for carers and ensured they could implement the plans.
• There were active service user groups in each locality. Staff offered patients training and coaching to enable them to be on interview panels, chair meetings and review documents relating to the service.
• Staff were motivated to provide high quality care. Access to the service was efficient and waiting lists were short. Staff supported patients to access physical health care from other services and developed documents with patients to help them express their physical and mental health needs. They supported patients during transitions between placements.
• Teams were well led. There were enough staff with the appropriate skills to deliver a safe and effective service. Staff told us managers were available and approachable. Managers praised staff for doing a good job. Managers monitored staff performance. They ensured staff were well trained, appraised and supervised. They enabled staff to develop their skills and pursue special interests. Morale was good.
• There was an open culture and a willingness to learn. Staff developed the service in response to learning from complaints and incidents. Staff welcomed feedback from patients and carers. There was a good structure of meetings for staff to discuss the safety and quality of the service. There were processes for escalating and monitoring service risks and staff were involved in the process.

However:

• Staff did not monitor if patients had been offered a copy of their care plan.
• Staff did not always document a Mental Capacity Act assessment when they needed to, such as when making best interest decisions about patients’ treatment.
• Some staff were stressed by frequent change and demands from the trust. Staff described having to respond to directives from senior management which they felt were sometimes risk aversive and less relevant than local issues.
• There were information technology connectivity issues at two of the team bases that was causing stress to staff.

Updated 3 October 2018

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

• All the environments we visited were comfortable, clean and welcoming. Environments had disabled access and toilets. Conversations could not be heard from outside interview rooms and staff were aware of issues around privacy and dignity during confidential interviews. Clinic rooms were well equipped and maintained. Staff made sure equipment was checked regularly.
• There were no waiting lists at the service due to the efficiency with which referrals were handled and caseloads were manageable within the teams. Staff completed risk assessments on admission and ensured regular monitoring of patients’ physical and mental health.
• All patients had care plans in place which contained risks and interventions. Staff were focussed on the health and wellbeing of patients. Staff involved carers in assessment and treatment and offered support and advice on issues and services. Patients, families and carers told us they were happy with the care received.
• Teams discussed clinical and managerial issues in weekly multidisciplinary meetings. Staff attended mandatory training and knew how to raise a concern. There were seven serious incidents reported in the previous 12 months. Reporting systems were in place and staff across the trust learned from incidents.
• There was evidence of good leadership in all teams. Managers were visible and supportive, and motivated their teams to create a positive culture. Staff morale was generally good and vacancy rates were low across the teams. Sickness was monitored and managed well in most teams.
• Staff were positive about the leadership in the trust. Staff were also aware of the senior management team, and told us that senior managers were visible and accessible.

However:

• Clinic rooms did not have alarm systems fitted and staff did not carry personal alarms.
• Although risk assessments were completed on admission, they were not always updated in the patient records. The quality of risk assessments varied across the service.
• Staff did not always report incidents that should have been reported.
• Some medicines that required storage below certain temperatures were not stored in a temperature controlled environment.
• Staff did not always make a safeguarding referral when they had identified potential safeguarding concerns.
• Patients did not always get offered their care plans and patient records did not show that staff offered care plans.
• Some teams did not keep records of staff clinical and managerial supervision.
• The provision of psychological therapy varied across the service, with one team having no access to psychological therapy.
• The provision of office space in New Forest East, Parklands and Gosport was not sufficient to allow staff to complete their roles adequately.

Updated 10 February 2022

Updated 10 February 2022

Updated 10 February 2022

Updated 3 October 2018

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

• The wards were tailored to meet the needs of individual patients. Both wards were recovery orientated and planned discharge from the point of admission.
• The wards were clean and well maintained. Environmental risks were identified and managed. Clinic rooms were clean, contained sufficient equipment and had access to emergency medication.
• Staff were caring and compassionate towards patients. Patients told us staff were respectful towards them and supportive. Staff were experienced in rehabilitation and understood the needs of patients well. Staff completed risk assessments and updated these regularly. Staff were knowledgeable about how to identify a vulnerable person was at risk and how to raise a safeguarding alert.
• We saw evidence of good physical healthcare of patients on both wards. Patients were assessed on admission and monitored regularly. The wards operated a staged self-administration of patient medication.
• Staff knew how to report incidents and provided examples where learning from incidents had been implemented. Learning from incidents was disseminated to teams in meetings.
• Care records were holistic, recovery orientated and discharge focused. Care plans covered all areas of well-being. Patients were involved in the development of their care plans from admission, could contribute their views and preferences and had copies of the plan.
• The wards both had a good multi-disciplinary team and worked collaboratively. Staff were experienced in rehabilitation and understood the needs of patients. Staff were up to date with mandatory training.
• The wards actively engaged with families and carers. Families and carers were invited to meetings, provided with detailed information and told us they were involved in the care of their relatives.
• Patients could access meaningful activities on the ward and were encouraged and supported to engage in activities in the local community. Activities were available seven days a week.
• Patients were provided with vast amounts of information. Patients received a welcome pack on admission and there was lots of other information leaflets available on the wards.
• Both wards had clear admission criteria and worked with patients towards discharge planning. The average length of stay on the wards was between six and nine months. Patients were rarely readmitted to the service.
• The wards had clear admission criteria and completed initial assessments to measure a patient’s suitability for the service. The wards were tailored to meet the needs of individual patients.
• The wards had strong local leadership which provided stability and consistency in the quality of care. Staff felt supported in their roles and received regular supervision and appraisals. Morale among staff was high and they described the culture as open and transparent. Staff knew how to raise concerns and felt able to do so.
• There were good governance arrangements in place to monitor the quality of care provided. Governance and performance management arrangements were proactively reviewed and reflected best practice.

However;

• There was limited input from clinical psychologists available to patients on both wards.

Updated 10 February 2022

Updated 21 April 2023

We rated the acute wards for adults of working age and Psychiatric Intensive Care Units core service as requires improvement because:

• Some areas that required improvement at the last inspection in October 2021 still needed to be improved. The trust therefore needed to consider the effectiveness of its internal governance arrangements so that potential issues could be identified and addressed promptly in future.
• Patients at Antelope House did not always have their physical health monitored as frequently as it should have been. We reported this to senior leaders who took immediate action to ensure staff understood their responsibilities in relation to monitoring the physical health of patients.
• The process for safely managing controlled drugs was not always followed by staff on Cherry and Juniper wards at Parklands Hospital.
• Staff did not always complete the necessary enhanced patient observations at Elmleigh.
• Patients at Elmleigh were not always promptly reviewed by a doctor on admission to the service and did not therefore have timely access to their required medicines. This posed a risk of missed doses.
• Improvements were needed to ensure staff had received the necessary mandatory training to safely fulfil their roles. At Elmleigh, most staff had not recently completed training in prevention and management of incidents of violence and aggression, during which they learn how to use safe restraint techniques.
• Some blanket restrictions were in place that unnecessarily restricted the comfort, privacy and dignity of patients. These included patients not being able to lock their bedroom doors, not having access to their own private lockable space, not being able to control the viewing panels in their bedroom doors and sometimes relying on staff to locate cups for them to access drinking water.
• Staff did not always receive regular supervision. Supervision compliance was particularly low at Elmleigh, Antelope House and on Juniper ward at Parklands Hospital. This posed a risk that staff would not receive the support they needed to fulfil their roles safely and confidently. However, a new project group had been set up to improve supervision compliance and review the style of staff supervision.
• Staff sickness rates at Elmleigh were increasing. Staff turnover rates varied across the core service according to hospital location. Turnover was highest at Antelope House. These factors meant that patients were less likely to receive continuity of care from staff who knew them and understood their needs and preferences.
• Although there had been progress made in relation to staff recruitment since the last inspection, there was still a significant number of vacant posts that needed to be recruited to.
• There was significant demand for beds. Abbey ward, a 10-bed female Psychiatric Intensive Care Unit (PICU), was closed at the time of the inspection. However, the trust had commissioned additional PICU beds in the independent sector to help manage this demand.

However;

• Staff now clearly recorded when clinical equipment was last cleaned at Elmleigh and Antelope House.
• The process for monitoring the physical health of patients receiving high doses of antipsychotic medicines had been strengthened.
• Patients now had their own copies of care plans and had been involved in developing their own care plans and risk assessments.
• Staff felt more able to speak up about their concerns without fear of retribution. They also knew how to escalate concerns using the trust’s freedom to speak up guardian.
• Staff now managed patient safety incidents well and staff received appropriate support if they were involved in an incident.

Updated 3 October 2018

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

• All patients had a risk management plan, and a crisis plan where appropriate. Most patients had next of kin details recorded and consent to share information details had been completed.
• Staff responded promptly to a deterioration in a patient’s mental health. Patients were placed on ‘shared care’ when their mental health deteriorated. Patients would receive extra home visits from a care co-ordinator to provide additional support on weekdays, evenings and weekends.
• Some teams had physical health leads responsible for ensuring patients’ physical health was monitored and their needs were met.
• Teams learnt from incidents and shared learning across teams and the trust.
• Caseloads sizes were continually being monitored and caseload sizes had reduced since the last inspection.
• Staff provided a range of care and treatment interventions suitable to the patient group, for example, running dialectical behavioural therapy groups for those with a personality disorder diagnosis.
• Staff were passionate, compassionate, knowledgeable and proud of their work. Teams were cohesive and supported one another.
• All teams proactively tried to contact patients who had missed scheduled appointments and who were reluctant to engage in the service. Staff made phone calls, sent letters and did cold calls to follow-up with patients who had not made contact with the service following a missed appointment.
• Managers ensured staff were regularly supervised and appraised. Teams held regular structured and effective meetings such as team, shared care, multidisciplinary and business meetings. Teams were well-led.
• Managers had clear action plans and were continually working towards improving the service provided to patients.
• There was an emphasis on improving involvement from patients and carers in the development of the service.

However:

• Not all of the teams were adhering to the trust’s safeguarding policy and making safeguarding referrals directly to the local authority. Procedures for making referrals to the local authority differed across teams. The procedure was particularly unclear at the Southampton teams.
• Patients on clozapine, an anti-psychotic medication which requires regular physical health monitoring, did not always have a relevant medication care plan.
• Care plans were not always person-centred, holistic and recovery-orientated. Some patients did not have a care plan.
• Care plans were difficult to access on the electronic patient record system as staff did not save the document in the correct place and used various formats.
• We could not find evidence that patients had always been offered a copy of their care plan or were involved in their care planning. Some patients we spoke to were not aware of their care plan.
• Managers were not using supervision sessions to ensure staff improve the quality of patient’s’ care plans.