Hampshire and Isle of Wight Healthcare NHS Foundation Trust

Updated 3 July 2026

With an annual budget of approximately £889 million, Hampshire and Isle of Wight Healthcare NHS Foundation Trust provides care and treatment to a population of around 2 million people. They employ approximately 13,000 staff across over 500 sites in Hampshire and the Isle of Wight.

The trust provides community and inpatient mental health services for children and adults across its patch including specialist and national services. The Trust is a combined mental health and community trust.

Hampshire and Isle of Wight Healthcare formed in October 2024 following the coming together of services from four Trusts with the aim to increase cohesive centralised care to the population from a single trust. The trust was formed with the formal merger of Southern Health NHS FT and Solent NHS Trust in October 2024. This was alongside acquiring some (but not all) services from Sussex Partnership NHS Trust & Isle of Wight NHS trust.

This is our first well-led inspection under the newly formed trust. We undertook a trust level (well-led) assessment, which included an onsite visit on 4, 5 and 6 November 2025. We also held 16 focus groups onsite and remotely and observed board and committee meetings between October and November 2025.

Since the formation of the trust there were ongoing changes to executive and non-executive directors on the trust board and the CQC wanted to assess the impact of this. We also received feedback about the culture of the organisation during the transition to the new trust.

The inspection took place at the time of significant pressures for healthcare services – especially those associated with crisis and acute mental health pathways. The CQC wanted to see how the trust was managing these pressures and working with system partners to support access to services. The CQC monitor serious incidents and wanted to understand how the trust was addressing learning from these incidents.

Prior to the well led review the CQC inspected the following assessment service groups (ASGs):

• Acute wards for adults of working age and psychiatric intensive care units
• Community-based mental health services for adults of working age
• Mental health Crisis Services and Health-based places of safety
• Forensic inpatient or secure wards
• Community urgent care services
• Child and adolescent mental health wards

We followed up themes from these inspections during the well led assessment.

We assessed all eight of the quality statements in the well-led key question used when assessing an NHS trust using our current framework.

Our positive findings from the well led review included:

The trust had undertaken significant work to successfully bring together the predecessor organisations into one new organisation. We heard that the next step was to carry out organisational transformation.

There was a clear commitment to compassionate and collaborative leadership as evidenced through the development of the trust strategy and partnership working.

We were impressed with the work to develop the lived experience leads for each division and the commitment to ensure a clear plan for their work remit and to protect their wellbeing.

The freedom to speak up guardian team were very positive and staff were aware of how to report a concern.

Staff we spoke with during the assessment service group inspections and the well led review had a clear passion to deliver good quality care.

We also identified areas for improvement which included:

Although the executive team lived and role modelled the values of the organisation we heard from frontline staff during our inspections, focus groups and staff survey responses that experience of local leadership was less positive and very different than the intentions of the executive leadership team.

Further clarity was required around lines of accountability, which were sometimes unclear due to overlapping portfolios between executives.

The trust did not have effective succession plans which meant that if a senior leader left their post, it might not be possible to recruit a replacement with the right skills and experience promptly.

Further work was required around equity, diversity and inclusion in the trust's recruitment process. The trust was aware this was an area which required specific focus in order to support the leadership development of staff from the global majority. Mentoring and coaching was happening in pockets but we did not see any structured plans or specific leadership development initiatives in place to support staff from the global majority or other staff with protected characteristics to advance into more senior roles within the organisation.

Quality statement summaries

Strategy summary

There was a current strategy in place for 2025-2030. The strategy was widely known by staff and beginning to embed into practice following sign off from board in July 2025. The strategy was co-produced with people who used services, staff and stakeholders to understand what mattered most and drive improvements. The strategy considered the demographic of the local population and a drive to align with neighbourhood and community working, with an emphasis on addressing health population outcomes.

Vision and values summary

The vision and values of the trust were recognised by staff and beginning to embed into the organisation. The refreshed set of values were launched alongside the strategy and observed through staff recognition awards and in each committee and board meeting. However, the vision and values were in their infancy and further work was required to ensure all staff were reflecting these in daily practice as the trust moved through transformation. There was mixed feedback from staff about leadership and their role modelling of the values with staff largely feeling that senior leaders were not demonstrating these.

Governance systems summary

The trust’s ability to measure success against its strategic objectives were outlined in their Board Assurance Framework (BAF). The BAF had been refreshed in line with the implementation of the new strategy to be reflective of the strategic aims and ensure accountabilities. The BAF was recognised to be under development, but it had improved from previous versions. The BAF had been challenged at October board by Non-Executive Directors for a lack of date timelines for identified actions.

There was an organisation-wide risk framework that sat underneath the BAF containing all reported risks by division and local structures with plans to address each. However, there were no target dates for completion of identified actions to ensure effective oversight of risk and accountabilities. The board were cited on key risks through appropriate governance streams and committee meetings.

Leaders at the trust recognised that there was further work required to enhance governance oversight following formation of the trust but acknowledged that it had improved over the past few months with the recruitment to executive leadership roles. For example, the trust policy library was still in the process of harmonisation with some policies still in existence from legacy organisations. The quality oversight group had overly detailed lengthy agendas making it challenging to assess outcomes relating to risk and delivery effectively.

There was appropriate oversight of clinical risk and performance. There were robust processes in place to oversee cyber security and information governance.

Information systems summary

There were systems and processes in place to support board assurance including the use of dashboards, performance metrics and reports which were presented at committee meetings and board meetings by the appropriate staff members. The structure of some of these meetings was under review following newly recruited Non-Executive Directors (NEDs) and executive leaders. For example, the quality and oversight committee agenda was identified as being overly detailed and ineffective in assuring leaders about the key issues impacting quality. There were plans in place to address this for future meetings. Dashboards were under review and development following the streamlining of data from former legacy trusts into one single dashboard to enhance oversight.

Freedom to Speak Up summary

Policies were in place for Whistleblowing and addressing concerns. There was an established Freedom to Speak Up Guardian (FTSUG) with ambassadors within the divisional structures. Staff were aware of the service and knew how to report concerns. However, some staff said that although they knew how to report concerns they would be reluctant to do so as they lacked confidence that their concern would be taken seriously, addressed, or feared retribution following reporting. Themes and trends reported were around bullying and workforce. The FTSUG reported confidence in maintaining independence and working with board to address concerns raised.

Compassionate and inclusive leadership summary

Leaders were visible within the trust and there was evidence of the commitment of the board to the equality, diversity and inclusion agenda. However, staff perception was that leaders were not visible. From our ASG assessments and well led focus groups some staff commented that when leaders were visible it felt superficial. There was a drive to ensure equality, diversity and inclusion were at the forefront of the agenda. However, this was in its infancy and required further work. The trust was working to become an anti-racist trust and had a strategic plan around this. However, themes of racism and inequalities were still being reported through FTSU, staff surveys and focus groups. Staff network chairs felt that some networks had strong input from their executive sponsors, however, others felt that there was limited support and a desire to step down as chair in the future due to challenges balancing work and chair responsibilities.

Workforce EDI summary

Whilst the board voiced a commitment to equality for all staff, there remained much work to do to ensure this resulted in fairness for all staff working in the organisation. There was evidence that the trust had built upon their previous legacy organisation data and made improvements towards Workforce Race Equity Standards (WRES) and Workforce Disability Equity Standards (WDES) data. However, they continued to perform worse than average in some metrics. Work was underway to drive improvements. This included having blind recruitment and the use of artificial intelligence to remove bias from the language used in job application adverts. There was also a plan to work with staff to promote staff from the global majority into leadership roles. However, at the time of the well led inspection limited progress had been made. Some staff spoken to from the global majority reported lack of promotion opportunities. Feedback collected in staff surveys included reports of experiences of racism, gender inequality and unfair disadvantage during the consultation processes if coming from a protected characteristic. Leaders were aware of a lack of succession planning and aimed to address this in the future.

Learning, improvement and innovation summary

The trust’s commitment to learning, innovation and research was evident. The trust described itself as becoming a learning organisation, but the priority had been on transformation and the formation of the new trust which had impacted this to date. The trust wanted to increase feedback from community organisations around improving patient outcomes and was in the process of embedding into all discussions. There was evidence of the commitment and passion within the provider collaboratives led by the trust. There were examples of partnership working and innovation in relation to involving communities and co-production. The trust was part of several accreditation programs.

Environmental Sustainability summary

Trust leaders were aware of the impact on environmental sustainability and could provide examples of how the trust had made changes to reduce the carbon footprint particularly within its pharmacy services. For example, reduction of carbon emissions from inhalers. Estates oversight was part of the BAF. There was a green plan in place with executive leaders holding this portfolio.

Updated 15 July 2025

We carried out an inspection of the trust’s mental health crisis services and health-based places of safety on 2, 3, 4 September 2025.

The crisis services and health-based places of safety form part of the trust’s mental health services in the community. This inspection was completed as part of CQC's Adult Community Mental Health Programme. We also inspected community-based mental health services for adults of working age as part of the programme. The programme of inspections contributes to CQC's commitment to inspect the standard of care in community mental health services across the country. We undertook a short notice announced, comprehensive inspection of this service, looking at all 5 key questions to assess if services are safe, effective, caring, responsive and well led.

Hampshire and Isle of Wight Healthcare NHS Foundation Trust was launched on 1 October 2024 when Southern Health NHS Foundation Trust, Solent NHS Trust and some services from Isle of Wight NHS Trust and Sussex Partnership NHS Foundation Trust merged to form 1 trust. This is our first inspection of the mental health crisis services and health based places of safety since the merger.

The trust has 5 Health Based Places of Safety (HBPoS), also known as a Section 136 suite, at:

• Antelope House
• Elmleigh Hospital
• Parklands Hospital
• Sevenacres (Seagrove Ward)
• St James Hospital (The Orchards).

A Section 136 suite is a facility for people who are detained by the Police under Section 136 of the Mental Health Act.

There are 6 crisis resolution home treatment teams (CRHTT)

• East
• Mid and North Hampshire
• Southampton
• South West
• Isle of Wight (IoW)
• Portsmouth

Hampshire and Isle of Wight Healthcare Foundation NHS Trust is part of the Hampshire and Isle of Wight Integrated Care System (ICS). The population of the Hampshire and Isle of Wight ICS area is over 2 million, with significant health inequalities across different local authorities. There are 4 local authorities, Hampshire, Isle of Wight, Portsmouth and Southampton. There is a higher proportion of white people across 3 out of the 4 local authority areas. Southampton and Portsmouth are the most deprived local authorities; deprivation is linked with poorer health outcomes. Southampton and Isle of Wight have poorer health index scores, higher suicide rates in males, and higher emergency admissions for intentional self-harm in females than the national average. Suicide rates are significantly higher for males in Isle of Wight and Southampton; female suicide rates are also above national averages in Hampshire, Southampton, and Portsmouth. Emergency hospital admissions for self-harm are significantly higher across all 4 local authorities compared to national figures.

During the inspection we:

• visited all 5 HBPoS and the Isle of Wight CRHTT, Portsmouth CRHTT, East CRHTT, Mid and North CRHTT, South West CRHTT, and Southampton CRHTT,
• spoke with 93 members of staff of various grades and roles through interviews and focus groups,
• spoke with 20 people who used services and 3 relatives and carers of people who used services,
• reviewed 59 care records for people who used services, including medicines records
• observed various meetings and interactions including care being provided,
• spoke with external agencies and organisations,
• and reviewed various documents in relation to the running of the service.

At this inspection we rated the service as Requires Improvement. We rated safe, effective, responsive and well led as Requires Improvement and caring as Good. We found 7 breaches of regulation related to

• governance across the trust, including governance of the HBPoS processes, safeguarding processes, environmental oversight, risk assessment, care records, and audits,
• staffing, compliance and oversight of mandatory training, lone working, appraisals and supervision,
• the use of HBPoS as seclusion rooms,
• access and availability of the HBPoS,
• direct access to fresh air at the Orchards and Elmleigh HBPoS,
• trust response times for urgent and very urgent mental health care and oversight of this data,
• and recording and oversight of medicines.

We asked the provider for an action plan in response to the concerns found at this inspection.

Updated 3 September 2025

Date of assessment 24 to 25 September 2025: We visited four hospital locations as part of this assessment.

Ravenswood House has 5 wards altogether and provides care and treatment for male patients with a mental health disorder in a secure setting. During this assessment we visited four wards: Mary Graham, Lyndhurst, Malcolm Faulk and Ashurst.

Southfield is a specialist mental health inpatient service and provides care and treatment for people with a serious mental illness who are aged 18-65 years. During this assessment we visited Starling Gold, Starling Emerald and Robin Ward.Starling wards is for females and Robin ward is for males

Bluebird House and Austen House are specialist, secure mental health inpatient units that helps young people, both male and female, aged 12-18 years.

Forensic inpatient or secure wards were last inspected in 2021 under the previous provider, Southern Health NHS Foundation Trust and rated as Requires Improvement overall. During this inspection and under the new CQC framework methodology Bluebird and Austen House were now included and assessed under the whole assessment group of Forensic Inpatient or Secure Wards.

We carried out this unannounced assessment as part of our routine comprehensive assessment process. We assessed a total of 32 quality statements from the safe, effective, caring, responsive and well-led key questions and found areas of good practice. Our overall rating has changed from Requires Improvement to good. The wards had enough qualified, skilled and experienced staff to ensure people’s safety and meet their needs in a secure setting. The services had a proactive and positive culture of safety and minimised the use of restrictive practices. Staff assessed risks to patient's health and safety and mitigated those risks. Staff ensured medicines were managed safely. The service provided a range of treatments suitable to the needs of the patients cared for on a forensic ward. Staff actively sought information and listened to patients. The service valued a diverse workforce and worked towards an inclusive and fair culture by improving equality for staff. The trust fostered a positive culture where staff felt that they could speak up. Leaders worked well with their partners across the local system. Concerns about safety were listened to by senior leaders and safety events were investigated and reported thoroughly.

Updated 7 April 2025

• The acute wards were inspected between 29th April and 9th May 2025 during a comprehensive inspection.

We inspected 11 wards across 6 sites across Hampshire and the Isle of Wight.

We visited the following wards as part of this inspection:

• Cherry and Juniper wards at Parklands Hospital based in Basingstoke
• Trinity, Saxon and Abbey wards at Antelope House based in Southampton
• Elmleigh in Havant
• Osborne ward at St Mary’s Hospital based in Newport on the Isle of Wight
• Hawthorn ward at St James Hospital based in Portsmouth
• Sherwood and Rosemary wards at Melbury Lodge based in Winchester

This was the first inspection of the acute wards as part of Hampshire and Isle of Wight Healthcare NHS Trust. Hampshire and Isle of Wight Healthcare formed in October 2024 following the coming together of services from four Trusts with the aim to increase cohesive centralised care to the population from a single Trust.

Mental Health Act and Mental Capacity Act Compliance Summary

The trust was compliant with the Mental Health Act and Mental Capacity Act. We saw evidence of the code of practice being implemented on the wards. Staff were trained in the use of the Mental Health Act and Mental Capacity Act and regularly updated their learning.

Appropriate safeguards were in place for monitoring and administering the Mental Health Act on the wards.

Updated 25 June 2025

We inspected the Child and Adolescent Mental Health Service at Serenity Path Hospital on 24 October 2025.

Serenity Path Hospital is an acute adolescent psychiatric service providing inpatient treatment for young people between the ages of 13 to 18 years. The Hospital provides a comprehensive treatment programme for young people experiencing acute mental illness.

We inspected this service as part of our scheduled inspections as we had not inspected this service since February 2022. At that inspection we rated the service overall Good, rating Safe as requires improvement and rated Effective, Caring, Responsive and Well-led as Good. At that inspection we identified a breach of Regulation 18 Safer Staffing, and told the trust that they must ensure that there are always enough skilled and experienced staff deployed in all units at all times to keep patients safe and meet their needs. At this inspection we found that there were enough experienced staff employed across the service.

Mental Health Act and Mental Capacity Act Compliance Summary

Staff received training in the Mental Health Act and Mental Capacity Act. Staff could access support when needed about the use of the Mental Health and Mental Capacity Act. Staff explained their rights under the Mental Health Act to the young people admitted to the service.

Updated 15 July 2025

We carried out an inspection of the trust’s community-based mental health services for adults of working age on 2 to 4 September 2025. The community-based mental health services for adults of working age form part of the trust’s mental health services in the community. This inspection was completed as part of CQC's Adult Community Mental Health Programme. We also inspected mental health crisis services and health-based places of safety as part of the programme. The programme of inspections contributes to CQC's commitment to inspect the standard of care in community mental health services across the country. We undertook a short-notice announced, comprehensive inspection of this service, looking at all 5 key questions to assess if services are safe, effective, caring, responsive and well-led.

Hampshire and Isle of Wight Healthcare Foundation NHS Trust is part of the Hampshire and Isle of Wight Integrated Care System (ICS). The population of the Hampshire and Isle of Wight ICS area is over 2 million, with significant health inequalities across different local authorities. There are 4 local authorities, Hampshire, Isle of Wight, Portsmouth and Southampton. There is a higher proportion of white people, compared to the England average across 3 out of the 4 local authority areas. Southampton has a higher proportion of Asian and Asian British people and mixed or multiple ethnicity people, when compared to England. Southampton and Portsmouth are the most deprived local authorities; deprivation is linked with poorer health outcomes. Southampton and Isle of Wight have poorer health index scores, higher suicide rates in males, and higher emergency admissions for intentional self-harm in females than the national average. Suicide rates are significantly higher for males in Isle of Wight and Southampton; female suicide rates are also above national averages in Hampshire, Southampton, and Portsmouth. Emergency hospital admissions for self-harm are significantly higher across all 4 local authorities compared to national figures.

Hampshire and Isle of Wight Healthcare NHS Foundation Trust was created on 1 October 2024 through the merger of two NHS trusts (Southern Health NHS Foundation Trust and Solent NHS Trust), alongside service transfers from 2 other trusts (Isle of Wight NHS Trust and Sussex Partnership NHS Foundation Trust). This is the first inspection of community-based mental health services for adults of working age since the merger. As part of our inspection, we considered information and data provided by the trust for activity within the last 12 months. Some of this related to legacy organisations, as it was not yet available in the trust’s current format.

The trust’s community-based mental health services for adults of working age are spread across 4 geographic divisions:

• Mid and North Hampshire
• Portsmouth and South East Hampshire
• Southampton and South West Hampshire
• Isle of Wight

The trust had 3 communities of practice, which included 1 for working age adults. The communities of practice were designed to ensure the clinical divisions worked together to deliver clinical transformation and improvement and to ensure consistent standards. The way in which services were organised and delivered varied across the 4 divisions and across different teams. This included differences in governance systems.

During the inspection we:

• visited the early intervention teams at Isle of Wight and South West Hampshire, community mental health teams at Isle of Wight Central and West, Eastleigh, Southampton Central, Gosport, Portsmouth, Winchester, Andover, Rivers and Meadows. We visited the Access to Intervention team on the Isle of Wight and Assessment to Intervention team in Portsmouth.
• the medicines team visited 6 sites, where community mental health services for adults of working age were based
• spoke with 153 staff of various grades and roles, and carried out 2 focus groups
• interviewed the leadership team in each division,
• spoke with 40 people who used services and 2 carers,
• reviewed 79 care records for people who used services and 33 medicines administration records

At this inspection we rated the service as requires improvement. We rated safe, effective, responsive and well-led as requires improvement. We rated caring as good. We found 9 breaches of regulation relating to:

• waiting list management, including the monitoring of people waiting for services
• not meeting targets for contacting people within 72 hours of discharge from an inpatient ward
• the deployment of sufficient staff, who had completed mandatory training and received supervision and appraisal
• ensuring people received physical health checks
• ensuring people had current, person-centred care plans
• reading people their rights under section 132 of the Mental Health Act
• assessing non-urgent referrals within 28 days
• long waiting times for psychological therapies
• good governance

We have asked the provider for an action plan in response to the concerns found at this inspection.

Updated 15 August 2025

We inspected the Urgent Care Centre at Petersfield Hospital on the 23 September 2025. This was a comprehensive inspection; we carried out this inspection as we had not inspected this service since 2018. At our last inspection, the service was rated good overall and good for all key questions.

Urgent Treatment Centres (UTC) offer an alternative to using emergency departments. They can treat minor injuries and illness that are not emergencies but are urgent.

The UTC at Petersfield Community Hospital open 365 days a year for 12 hours a day between 8am and 8pm. It has access to an X-ray department which is open 7 days a week 9am to 4pm.

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

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 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