• Organisation
  • SERVICE PROVIDER

Southern Health NHS Foundation Trust

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

Overall: Requires improvement read more about inspection ratings
Important: Services have been transferred to this provider from another provider
Important: Services have been transferred to this provider from another provider
Important: Services have been transferred to this provider from another provider

All Inspections

18, 20 and 25 October 2022

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

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.

18 August 2021

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

We carried out this unannounced, focused inspection at Elmleigh Hospital in Havant to see if the hospital had made the required improvements identified at a previous inspection in April 2021. We visited both wards: red and blue bays. Red bay is a 17 bedded ward for female and blue bay a 17 bedded ward for males.

Following that inspection, we sent the trust a letter of intent under section 31 of the Health and Social Care Act 2008 identifying our serious concerns about the safety of patients at Elmleigh. Section 31 of the Health and Social Care Act 2008 Act is an urgent procedure whereby CQC can vary any condition on a provider's registration in response to serious concerns. However, a letter of intent asks the provider to set out, in an action plan, how it will address those serious concerns. If the action plan provides us with assurance that the provider will act in a timely manner and if we are assured, we then don’t take any further action.

In the report we also identified some additional improvements that the trust needed to make to ensure it met legal requirements. We told the trust it must ensure that patients’ physical health care needs were met, that mental health assessments were undertaken prior to section 17 leave, that all patients had access to meaningful activities and psychological interventions, that all incidents must be reported, that staff received an induction and regular supervision, that medicines were managed safely and that there were robust governance arrangements in place to identify risks so that improvements could be made as needed.

In May 2021 the trust sent us an action plan detailing how it would meet the above legal requirements, which detailed what had been done immediately following our inspection to make improvements and what it would do to ensure further improvements were made in a timely manner. This provided us with the assurance we required so we did not take any further action.

At the latest inspection we did not rate this service because we did not look at all the key questions or all the key aspects of the key questions. The previous rating of good remains. It should be noted that this rating related to all of the acute mental health services at Southern Health and not just Elmleigh.

We found that the trust had met the majority of the required improvements but that there were still some further improvements to be made.

At Elmleigh we found:

  • Staff provided a range of care and treatment interventions suitable for the patients that were in line with national guidance on best practice. Patients had access to meaningful activities and psychological and therapeutic interventions.
  • New staff received a comprehensive and tailored induction to the wards and received regular supervision, including reflective practice sessions and group sessions.
  • Staff felt supported and were more confident about raising concerns.
  • The governance arrangements had improved, and ward managers had implemented additional checks and audits to identify where improvements were still needed and action could be taken promptly.
  • Staff ensured that patients’ physical health needs were identified and assessed. Patients had appropriate physical health care plans in place which were reviewed regularly.
  • Improvements had been made with regards to patients’ mental state being assessed prior to taking leave from hospital. However, some patients told us that sometimes their mental state wasn’t assessed prior to leave.

However:

  • Staff were not increasing physical health observations in line with National Early Warning Score (NEWS2) protocol when patients’ health deteriorated. For example, if a score increased from two to three, patients were not having their observation checks increased from every 12 hours to every six hours. Patients’ baseline scores were missing and there was no rationale recorded for why these increased observations did not take place.
  • Staff were still not always reporting all incidents. For example, if an incident was a regular occurrence or was low risk of harm.
  • Although improvements had been made to medicines management, there were still gaps in recording on medications charts.

How we carried out the inspection

During the inspection visit, the inspection team:

  • interviewed the ward managers and spoke to the head of operations
  • spoke with nine members of staff, including four nurses, one health care assistant, one assistant psychologist, one clinical psychologist, one activity co-ordinator and one HR advisor
  • spoke with the user involvement manager for mental health, learning disabilities and specialities services for the trust
  • spoke with five patients across both wards
  • reviewed a sample of patient care and treatment records
  • reviewed all patient medication charts, controlled drug book and physical health observation records across both wards
  • reviewed a sample of section 17 leave documentation (permission for a patient to leave the hospital)
  • reviewed a sample of incident reports and
  • looked at policies, procedures and other documents relating to the running of the service.

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

What people who use the service say

We spoke to two patients on blue bay and three patients on red bay. All patients we spoke to said that there were lots of activities to do now but that staff sometimes did not encourage them to take part. Patients told us that they had their mental state assessed prior to leave but sometimes this did not happen. Patients also said that their leave could be cut short due to staff shortages and it was difficult to access leave for regular cigarette breaks.

21 and 26 April 2021

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

We carried out this unannounced, focused inspection because we received information about the safety and quality of the service. The concerns were specifically about Elmleigh, which is one of the acute mental health hospitals in the trust. The concerns were about a lack of therapeutic intervention from staff and activities for patients, incidents not always being reported, observations of patients not being therapeutic or engaging, patients being unable to take regular leave from hospital due to staffing levels, issues with medication administration and a poor culture amongst the staff team at all levels.

We inspected both wards at Elmleigh, in Havant. Red bay and Blue bay are acute wards for adults of working age. Red bay is a female-only 17-bedded ward and Blue bay is a male-only 17-bedded ward.

We inspected the service on 21 April 2021 due to the concerns raised above. However, during the inspection we had significant concerns about the lack of robust the monitoring of patient’s physical health care. We therefore returned on 26 April 2021 to look more closely at this specific issue.

On 29 April 2021, following this inspection, we sent the trust a letter of intent under section 31 of the Health and Social Care Act 2008 identifying our serious concerns about the safety of patients on Blue and Red bay wards and requested the trust submit information to explain how they would make immediate improvement. Section 31 of the Health and Social Care Act 2008 Act is an urgent procedure whereby CQC can vary any condition on a provider's registration in response to serious concerns. A letter of intent sets out our intention to take urgent action if the provider does not assure us that it will make the required improvements urgently.

On 4 May 2021 the trust sent us a detailed action plan which provided assurance on what had been done immediately to improve care and treatment on the ward. We therefore did not take any further enforcement action but will continue to monitor the action plan closely to ensure the trust makes the improvements within the timeframe it has set out.

Following the inspection, the trust also voluntarily capped admissions by reducing the bed numbers on each ward by three.

We did not rate this service at this inspection because we did not look at all of the key questions or all of the key aspects of the key questions. The previous rating of good remains. It should be noted that this rating related to all of the acute mental health services at Southern Health and not just Elmleigh.

At Elmleigh we found:

  • There was not enough staff with the right skills and knowledge to ensure that patients had high quality care and treatment. The ward did not have a full multi-disciplinary team and were missing input from key disciplines such as clinical psychology and occupational therapy. There was only one locum consultant psychiatrist covering both wards. There was a high number of agency staff deployed who did not always know the patients’ needs and risks. Nursing and healthcare staff were stretched, busy and did not have the time to regularly complete incident forms, therapeutically engage with patients or arrange activities. Staffing was not increased when the acuity on the ward increased, for example when additional patients required extra observations to monitor their risk.
  • Staff did not always assess or monitor all risks to patients, including mental health and physical health. We found that the physical health needs of eight patients with known conditions and risks had not been adequately assessed or monitored. Staff did not always assess risk prior to patients taking approved leave from hospital as they did not complete a mental state assessment. When completing observations of patients, staff were not considering a patient’s risk or therapeutically engaging with patients. Staff recorded basic details such as ‘appears asleep’, ‘in bed space’ or ‘in ward area’.
  • Patients did not always receive a range of care and treatment interventions suitable for an acute mental health ward for adults of working age that was consistent with national guidance on best practice. Meaningful activities on both wards were lacking. The wards had been without therapy and activity staff for some time and nursing and healthcare assistant staff were not proactive in providing activities on the ward.
  • The ward team did not include and did not have access to the full range of specialists required to meet the needs of patients on the wards. The trust had not ensured that all staff had access to training to enable them to have a range of skills needed to provide high quality care. Staff did not receive regular formal clinical or management supervision. Agency staff and new starters did not always receive a full induction to the ward.
  • Staff at all levels did not feel supported by the trust. Staff did not feel listened to and felt their concerns were not taken seriously. Staff told us they were stretched, stressed, burnt-out and that they were too busy and constantly “fire-fighting”. Morale across both wards was low.
  • The trust did not have robust governance arrangements in place to ensure managers had adequate oversight of areas of risk and improvement such as meaningful activities and psychological interventions, physical health monitoring and reporting of incidents.

However:

  • Staff followed best practice in anticipating, de-escalating and managing challenging behaviour. Staff used restraint and seclusion only after attempts at de-escalation had failed. The ward staff participated in the provider’s restrictive interventions reduction programme.
  • The trust had recently recruited to the occupational therapy, psychology and activity co-ordinator vacancies.

How we carried out the inspection

During the inspection visit, the inspection team:

  • interviewed the deputy director of nursing for mental health
  • interviewed two ward managers
  • spoke with 13 members of staff, including four nurses, five health care assistants, one occupational therapy technician, one consultant psychiatrist, one ward clerk, and one human resources assistant.
  • spoke with seven patients
  • reviewed all 34 patient care and treatment records
  • reviewed all 34 patient prescription charts and physical health monitoring forms
  • reviewed a sample of observation records
  • reviewed a sample of incident reports
  • attended a multi-disciplinary team meeting and
  • completed an observation of the communal areas of both wards.

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

What people who use the service say

Patients told us that staff were nice, caring, treated them with dignity and respect but were always busy. Leave was often cancelled, or time was reduced due to staff shortages. Patients said they would like to do activities but there currently weren’t any. Patients said although there are always staff around, they are not always able to interact with them and they spend most of the day in their bedrooms.

Wednesday 5th August 22020

During an inspection of Child and adolescent mental health wards

We carried out a focused inspection of Austen House, a child and adolescent mental health unit at Southern Health NHS Foundation Trust.

The trust provides child and adolescent mental health wards in three locations: Bluebird house, Leigh house and Austen house. Austen house is a standalone unit with one ward set within its own grounds, close to the Tatchbury Mount site.

The wards are registered to provide the following regulated activities:

  • Assessment or medical treatment for persons detained under the Mental Health Act 1983.
  • Treatment of disease, disorder or injury.
  • Diagnostic and screening procedures.

We visited Austen house following concerns raised from a Mental Health Act remote review of the ward. Young people had told the reviewer that there was not enough staff and this was impacted on their access to education, therapy, activities and that they had to wait a long time before being able to access the garden and mobile phones to call relatives. There were also concerns that due to the high number of incidents and young people on high level of observations that there were not enough staff to ensure young people received adequate support in a timely manner. At the time of the inspection two young people required nasogastric feeding. This is a method of feeding via a tube from your nose to your stomach. There were concerns that not all staff had been trained to complete this procedure.

As we visited only one ward in this focused inspection, the rating from the previous inspection still applies and this inspection will not include a rating.

We conducted an unannounced focused inspection looking at specific areas of the following key question:

  • Is it safe?

During this inspection, the inspection team:

  • Visited Austen house, looked at the environment and observed care
  • spoke with the ward manager
  • spoke with five staff including three nurses, one student nurse and two healthcare assistants remotely
  • spoke with six young people over the phone as part of the Mental Health Act remote review
  • spoke with six carers over the phone as part of the Mental Health Act remote review
  • looked at five care and treatment records of young people
  • reviewed incident reports
  • looked at the previous three months of staff rotas, staff induction files and training matrix and other documents relating to the running of the wards.

08 – 10 October 2019

During a routine inspection

Our rating of the trust improved. We rated it as good overall because:

  • We found that the trust 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 clear vision, underpinned by a set of values that were well understood by staff across the trust. We noted some really clear thoughts and developments around aligning with partners across the health and care economy to further develop services that put patients at the centre of care. The trust was taking a leading role in a number of the system wide developments and the chief executive was leading on progressing mental health services.

  • The leadership team had taken significant steps to improve the culture across the trust and this was paying dividends. Staff across the trust felt valued but there was a real focus on doing what was best for people, both staff, patients and carers and a real commitment to the delivery of good quality patient care at every level. Staff at all levels of the trust were proud to work there and morale amongst staff was good. Both the Council of Governors and the trade union representatives were very positive about how the trust leaders worked with them in an open and transparent way.

  • Leaders ensured there were structures and robust systems of accountability for the performance of services. There was a clear focus on delivering high quality care whilst maintaining clear oversight of finances. Some positive work had been done with commissioners to identify the underfunding in mental health services and the trust was working with commissioners to address this in order to ensure the sustainability of services in the future.

  • There were some positive developments around succession planning at senior level and thinking to the future in developing the ‘rising stars’; including some really good work around equality and diversity to ensure the senior leaders of the future were representative of the population the trust served and the staff group.

  • The leadership team had engaged proactively with a number of families who had previously not received the appropriate level of care, consideration and investigation into their loved one’s deaths or poor experience of care (under a previous leadership regime). Each family worked with a senior member of the trust's leadership team of their choosing in a partnership arrangement. The trust partners included a member of the executive team and a deputy director of nursing as well as both medical and clinical directors. In late 2018, the trust sought the assistance of NHS Improvement to help address the outstanding concerns of five families which then commissioned an independent review undertaken by an experienced barrister. This report is due to be published in January 2020.                   

  • All in the trust had worked hard to address most of the concerns we raised in the last inspection. Two out of the four services we inspected (acute wards for adults of working age and tier 4 child and adolescent mental health services (inpatients), which were previously rated as requires improvement, have been rated as good following this inspection. Two services (wards for older people with mental health problems and crisis and health based place of safety) remain requires improvement but several improvements have been made.

  • Staff put patients at the centre of everything they did. Staff treated all patients with compassion, respect and kindness. The privacy and dignity of patients was maintained. Patients were supported by staff to understand and manage their care and treatment. Staff actively involved families and carers of patients in their care appropriately. For example, families were heavily involved in the development of Austen House, the new child and adolescent low secure inpatient unit.
  • Services had enough medical and nursing staff to keep patients safe and meet their needs. Most teams in the organisation had access to a full range of specialists required to meet the needs of patients in their care. Care was planned and provided in a way that met the needs of local people and the communities the trust served. Staff met the needs of patients with a protected characteristic. Staff supported patients with communication, advocacy and cultural and spiritual support.
  • The trust had made some really positive steps in implementing quality improvement work across the organisation. The pace of progression had been considerable even though it was still early days but staff at all levels were enthusiastic although there was still much to do to ensure quality improvement work was embedded in all areas. The trust had employed an expert by experience specifically to engage in engage in quality improvement projects. Their role was to ensure co-production at all levels. All the improvement initiatives involved patients and/or carers; there were 250 patient/carers involved in initiatives across the trust.
  • The trust managed incidents well and investigated them thoroughly. Staff understood how to report them appropriately. Lessons were learned from incidents and shared with staff across the trust. The trust was also progressing some positive work around learning from deaths.
  • The trust treated concerns and complaints seriously. The organisation investigated concerns and complaints and shared lessons learned with staff. Patients were included in the investigation of their complaint.

However:

  • The trust had not yet made all of the improvement that we identified needed to be made at the last inspection in older people and crisis services.

On wards for older people with mental health problems:

  • Female patients did not always have a female-only designated area to use as the female-only lounges were accessed by male patients.
  • Staff across the services had limited understanding about the use of Mental Capacity Act.
  • Patients on five of the seven wards had limited access to a clinical psychologist and psychological therapies.

On crisis and health based place of safety suites:

  • Due to recent changes in the way crisis services and health-based places of safety suites were managed both managers and staff of the services were unclear who the senior manager was who held responsibility for the service. 
  • Staff in the crisis teams did not consistently develop and record holistic, recovery-oriented care and crisis plans informed by a comprehensive assessment and in collaboration with families and carers.
  • Senior leaders did not have assurance that the trust was meeting its legal obligation to ensure people did not stay in the health based places of safety longer than 24 hours or had an extension granted by an approved person because staff were not consistently completing the required hourly checks or recording information accurately.

In addition, we found:

  • That the board, particularly the non-executive directors were not representative of the community Southern Health served or the staff group. This was known and high on the trust’s agenda.
  • In older people’s services staff did not work in line with the trust policy on handling and disposal of healthcare waste.
  • Patients on Beaulieu ward (older people’s services) were unable to call for a nurse in the event of an emergency from their bedroom areas. Staff told us that call bells had been removed during refurbishment and had not been replaced by any other means for patients to call for help.

20 February 2019

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

Prior to the inspection, in response to concerns raised by patients, staff and the local leadership team regarding the safety and quality of care at Antelope House the trust had made a number of key changes to the staffing structure including new leadership and additional checks on safety and support for staff. The trust introduced these key changes on 11 February 2019 so had only been in place nine days prior to our inspection.

Prior to the new staffing arrangements being implemented the senior management team spent time talking with staff, visiting the wards to ensure they understood the issues facing staff and consider what changes needed to be made to make improvements to the quality and safety of patient care.

Changes had been made to managerial and nursing roles and additional medical support was put in place to support staff. Daily safety huddles were also set up to discuss risks and concerns within Antelope House. Changes were communicated to staff in writing and in person. However, these were new and not fully embedded.

During the inspection, we found:

  • Staff had not ensured that risks concerning a patient’s physical health had been fully addressed.
  • Staffing levels were not always sufficient and fell below the trust ‘safer staffing levels’ on both wards approximately once per week. There were a number of vacant posts on both wards and a high level of staff sickness. The wards were heavily reliant on bank and agency staff and some shifts were left short by one or two staff members once or twice per week.
  • Staff morale on Hamtun ward was low, three staff were off sick and the remaining staff team were feeling under pressure. Staff said that prior to the changes they had felt undermined by senior management regarding admissions to the wards and felt that communication had been poor.

However:

  • The trust had recognised that staff morale was low on Hamtun ward and had put in place arrangements to bring about improvements. During the inspection staff told us told us that they felt there had been more support from senior management recently.
  • The trust had implemented daily safety huddles to discuss any concerns on the wards and provide additional support to staff and monitor patient safety.
  • Staff on Saxon ward felt that morale was good.

21 May 2018 to 05 July 2018

During an inspection of Community end of life care

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.

Elmleigh: 25 and 27 April 2017; Antelope House: 5 and 6 June 2017

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

We found the following areas of good practice:

  • The trust had taken significant steps to address the serious concerns raised at the last inspection to address the issues within the seclusion room at Antelope House. The trust had invested considerable resources to re-design the seclusion room and high care area and bring it in line with the requirements of the Mental Health Act code of practice. The layout and décor of the seclusion room and the high care area had been well considered and constructed to be as non-threatening an environment as possible for unwell patients.
  • Patients were very complimentary with regard to the level of care they received from the staff and the atmosphere on the wards at the time of our inspection was calm and we saw very positive interactions between staff and patients.
  • The staff we spoke with were knowledgeable about the patients on the ward and the staff team were passionate about achieving positive outcomes for the patients.
  • The senior management team had committed resources to analysing the issues of concern on the ward and there was clear planning with regard to driving improvements across the hospital, this included increasing the numbers of restraint trained staff on the wards, increasing staffing levels and skill mix across the wards too.
  • The trust was adopting innovative ways to attract new staff into the service and was also offering developmental opportunities to existing staff.
  • The ward environments were clean and well presented.

However, we also found the following issues that the service provider needs to improve:

  • There were some concerns with regard to examples of poor communication between the senior management team and staff on the wards; this included a lack of clarity with regard to the number of restraint trained staff that should be present within the hospital, and a significant change of plan with regards to the re-opening of Hamtun ward following the redesign of the seclusion room. Staff told us that they felt the trust had been dishonest in its behaviour around the re-opening of Hamtun ward and that their concerns for staff and patient safety had not been heard by the senior management team. Despite the lack of understanding by staff of the number of restraint trained staff considered by the trust to be safe on the wards; the trust was working within the policy by having five PRISS trained staff on duty across the site.
  • The seclusion records at Elmleigh were not completed correctly, the rationale for the seclusion was not always in line with the Mental Health Act (MHA) code of practice and where patients had been secluded more than once in a short time period it was difficult to follow the processes and to be sure that reviews had taken place appropriately. The records did not always state the legal status of the patient, the trust initially told us that where there was no information with regard to the status of the patient on the form then the patient was an informal patient and not detained under the MHA. However at a later visit to the trust we were told this was a recording error and staff had not completed the forms appropriately.
  • The trust was using the place of safety 136 suite at Elmleigh for seclusion of patients. This is contrary to the MHA code of practice and is contrary to the trust seclusion policy.

27 – 30 March 2017

During an inspection looking at part of the service

We did not re rate the core services inspected or the overall provider following this inspection.

At the time of our inspection, the trust was going through a significant period of change. The recently appointed interim chair and interim chief executive were implementing a considerable change programme. This included a change in leadership at board level and at service level (particularly in mental health) and changes that were intended to bring about improvements across all services. The trust recognised that there was still much work to do and that whilst we found it had made some significant improvements across the trust we found concerns in a number of areas.

During the comprehensive inspection of the trust in 2014 we told the trust it must make improvements in a number of areas but during this inspection we found that some of the required improvements had not been made. For example, at the previous inspection we found there had been delays in provision of special mattresses and beds for patients approaching the end of their life in both the community hospitals and at home. On this inspection we found that there were still delays in this provision although the trust was continuing to work with commissioners to try and address the issues.

Within the community health service for adults, there were still significant delays in the provision and repair of wheelchairs. This affected the safety and well-being of a large number of patients.

The requirement to review and amend the management of FP10 prescriptions had not been met. On the trust intranet, there was guidance on how to order and store FP10 prescriptions but there was no guidance on how staff should record receipt of, issue and undertake checks of FP10s. Hence, there was variability across the trust on how staff managed FP10s. In addition, we found that medicines management and reconciliation in the community hospitals was not robust or managed in line with best practice guidelines and therefore compromised patients’ safety.

There was still inconsistent and varied practice in both community health services and older people’s mental health services in the completion of do not attempt cardiopulmonary resuscitation records and sharing of information.

During our previous inspections in the mental health and learning disabilities services, we had identified inconsistencies in the completion and updating of risk assessments. During this inspection, we found this continued to be an issue, particularly in the community adult mental health teams. The trust had introduced a number of measures to continue to address this, such as training, changes to the electronic record templates and supervision tools.

At this inspection we had concerns about some aspects of care at Gosport War Memorial hospital. In some areas, there was insufficient staff to meet the assessed needs of patients. Staff did not always store or administer medicines in line with manufacturer’s guidelines, staff did not consistently adhere to the trust’s infection control policy and not all staff had a good understanding of mental capacity assessments.

Patients, families, partner agencies and CQC had previously expressed significant concerns about the trust`s complaints processes, quality of responses and learning from complaints. The trust had implemented several changes to address this. Overall, the complaints governance systems in the trust had improved over the past 12 months but further improvements were still required. However, some members of staff, patients and families told us that they believed that the trust needed to do more and that they would like to see swifter action and much more effective communication related to complaints and investigations into incidents when things had gone wrong.

The trust recognised that there remained significant concerns and still much work to do in the way it communicated with, and involved, patients and families. It had formed a family engagement action task and finish group and recently established a ‘families first’ group. Members of the families first group were very positive that the trust had a commitment to driving this work forward and engaging more effectively with the patients, families and members of the public. A family liaison officer had been appointed and the interim chief executive was meeting regularly with a number of families to address their concerns.

However, we concluded that the trust had turned a corner. The interim chair and chief executive had a clear vision and understanding of what was required to bring about improvements and were committed to ensuring that improvement was made in a timely manner.

In October 2016, the trust initiated a review of how it provided services. This resulted in the development of a clinical services strategy. This had three key components: i. the development of a clinical strategy for mental health and learning disabilities services; ii. a review of the trust’s multi-speciality community provider work to make sure it was aligned with the mental health and learning disabilities strategy and iii. a review of how the organisation would be best structured to deliver the mental health and learning disabilities services for the new models of care. The majority of the trust governors told us that there had been a very open and inclusive approach to the development of the strategy.

Members of the council of governors and the majority of staff that we spoke with told us that they believed that the interim chair and interim chief executive were making a positive difference in changing the culture. They reported that there was now a clearer focus on quality, and that the trust leaders were improving governance processes and supporting improvements in service delivery. They also told us that trust leaders were more open and approachable than they had previously experienced.

Since our last inspection (September 2016) the senior leaders of the trust were a more visible to the frontline staff. This had been achieved through the implementation of an executive ‘back to the floor’ programme and listening events.

Overall, staff morale was good in the mental health teams we visited, although was more varied in the adults of working age community mental health teams. Staff morale in community health services on the whole had improved.

Staff in all areas of the trust responded to patients in a kind, caring and compassionate manner and treated them with dignity and respect.

There was a greater focus on ensuring that the trust implemented the actions in the improvement action plans arising from previous CQC inspections and from the review of serious incidents and mortality undertaken by Mazars. Managers monitored progress weekly and reported progress to the trust board.

There had been a notable improvement in the timeliness and quality of investigation reports following serious incidents, including deaths. In January 2017, the trust had completed 97% of the required mortality reviews within 48 hours of the death occurring (the figure was 78% in June 2016). Work had progressed to improve learning from these incidents but there was still work do to ensure learning from incidents that did not meet the serious incident threshold. In addition, we found that there was variable reporting and learning from incidents within the community health services that we inspected.

We will continue to monitor the trust closely and will undertake focussed inspections as needed. At some point in the future (in line with our methodology) we will undertake an inspection that will result in a review of the ratings across the trust.

28th March – 30th March 2017

During an inspection of Community-based mental health services for adults of working age

We did not rate this service on this inspection.

We found the following issues that need to improve:

  • The previous inspection found that there was inconsistent use of risk assessment and crisis planning for patients accessing the service. In addition, the investigation following a serious incident involving the death of a patient identified incomplete risk assessments as a learning point. On this inspection, we found that that assessing and recording of patient risks was not consistent. Staff did not always update risk assessments with new information, and there was poor and inconsistent use of the different crisis plans that the trust had provided staff to use.
  • There was variation in caseloads across the teams. There were particularly high caseloads at the Andover team. Although the trust had undertaken a review of the demand and capacity of the teams, some staff reported that caseloads were not manageable and that they had extra duties that were not taken into consideration.
  • We found that staff morale had been affected by the ongoing public scrutiny and coverage in the media, and the pressures from a recent split with adult social care.
  • There was a lack of recording of the next of kin information in patients electronic care records. This had implications for the duty of candour where staff needed to be able to contact family members in the event of an incident.

However:

  • There was positive use of the trust’s risk register to escalate risks, such as those with the environment and staffing. This ensured that there were both long and short-term plans for the mitigation of risks. Incidents were reported and investigated, and learning was cascaded through to front line staff.
  • There was a positive change in the oversight of the teams’ performance with the continued implementation of the trust`s electronic governance system. This allowed managers to check on key areas of performance within their teams to ensure completion of essential areas of practice.
  • Staff spoke positively of the mutual peer support within the teams; they felt supported through their immediate leadership teams.
  • The recent change to the trust`s executive board had improved top down communication; however, staff felt it was too early for the change in the board to have had a noticeable impact.

13 - 15 September 2016

During an inspection looking at part of the service

During this inspection (September 2016), we found that there had been a number of significant improvements made to the governance arrangements in order to identify and prioritise risks arising from the physical environment more effectively. The risks identified included those posed by ligature anchor points, falls from heights and from patients absconding. We saw clearer processes in place to ensure that the trust assessed the risks, tracked actions taken and that there were escalation processes in place where actions had not been undertaken or there were delays. Everyone we spoke with confirmed that there were much more effective relationships between the estates and clinical teams. We found that a range of anti-ligature work had been completed across the trust and that there was a much better appreciation of the need to drive forward and complete this work. Many of the staff and senior managers we met told us that it had become clear over the past six months that the trust were now more focused on patient safety and they were hopeful that mental health and learning disabilities services were now a higher priority.

Overall, staff morale was good. Staff felt positive about the changes taking place and the improvements to environments. However, there had been some significant changes at board and executive level and at the time of inspection, there was continued uncertainty and changes within the trust. There were a number of external reviews taking place, generating recommendations focussed on various aspects of the governance systems, including the board assurance framework, which the trust was in the process of putting in place. Whilst we recognised that the newly restructured leadership team had only recently come into post, it was our view that they demonstrated clearer recognition of the need to drive through and complete the work to assess, manage and prioritise a range of patient safety issues. There was clear evidence that action was being taken in a more timely and proactive manner.

The trust recognised that there was still significant work to do and that the new systems needed to embed. There needed to be clear assurance processes in place to ensure that effective actions had been completed. In addition, we had some areas of concern about specific sites – particularly Elmleigh. We identified on-going environmental issues at Elmleigh. In addition to the known ligature risks, during this inspection, we highlighted the layout of the wards meant that it was not easy for staff to observe patients in all areas – including those who might be at risk of acting aggressively, harming themselves or of absconding. The problem was compounded by four factors. Firstly, some of the ward fixtures and fittings could be used as ligature anchor points. Secondly, staff did not always manage the segregation of men and women well. Thirdly, there were not always a sufficient number of staff for staff to observe all areas of the ward. Fourthly, the local management team had not consistently reviewed and learned from incidents well. We raised these concerns at the time of inspection.

The trust had introduced a standardised safety and risk management plan to incorporate an individual’s risks in relation to the specific ward environment. We were told that every patient now had this in place, but found that there was no safety and risk management plan relating to the environment in a quarter of the 143 records we reviewed. We also raised concerns about risk assessment processes at Ravenswood House medium secure unit.

Overall, we concluded that the trust had taken sufficient action to meet the requirements set out in the warning notice. The trust remains in breach of a number of regulations of the Health and Social Care Act 2008 (regulated activities 2014) from the previous October 2014 and January 2016 inspections; as a result of this inspection the two additional regulation breaches are listed at the end of this report.

18 - 21 January 2016

During an inspection of Community-based mental health services for adults of working age

  • The adult community mental health services provided a range of mental health services for people in Southampton. Patients and carers had raised concerns that there was disjointed provision of crisis services across the area and some people waited a long time for an appointment with the community teams following a referral. The trust and local clinical commissioning group had identified that there were a number of key performance indicators of safety and quality. For example, the trust had benchmarked these indicators and found that there were higher than average complaints and serious incidents, which showed mental health services for people in Southampton were not being performing well.
  • We had a number of continued concerns. These included inconsistent recording in care records in relation to risk assessment and plans, and a failure to follow up patients who did not attend appointments. These were all aspects of care that have been identified as key risk issues in a number of serious incidents that had occurred but had not been addressed, at the time of the inspection, by the trust. We also found that supervision structures were not consistently embedded across the teams and as a result, staff did not always manage their caseloads effectively or monitor the quality of record-keeping.

However,

  • The area manager and team managers all demonstrated a good understanding of the challenges and risks within the service and were committed to continuing with the implementation of the improvement plan. Staff we met were reflective and supportive of the changes being implemented.
  • The trust board recognised that significant work was required at Southampton in order to ensure safe and effective services were provided. As such, an improvement team had been put in place by the trust, which developed a plan of action to achieve a number of changes. Staff had been consulted on the improvement plan in July 2015 and the first phase of the improvement plan had been implemented in November 2015. The main components of the first phase had been implemented at the time of inspection:
  • A redesigned community pathway had been introduced. The community teams were based across three hubs, central, east and west, delivering all functions of community mental health care, undertaking mental health assessments and, where allocation within the team was appropriate, a range of more specialist assessments and interventions.
  • A redesigned crisis care pathway had been implemented. One 24 hour team had been established, to be available seven days a week to support people who were acutely unwell, and either work with people at home or arrange admission and discharge from hospital where indicated. There was a plan to increase the psychiatric liaison service at Southampton General hospital by March 2016.
  • The plan included a focus on improving the pathway for people who were in hospital, ensuring people did not remain in hospital any longer than they need to and that local beds were available when people need admission
  • The implementation of the improvement plan was being overseen by an area manager who was well respected by all staff we met. It was the first permanent area manager in post for two years. Most staff felt consulted and engaged with the improvement plan and felt it would improve services. While it was clear there were still a number of improvements to be made and changes to be evaluated and embedded, we saw how proposed improvements to the care pathway would reduce the experience of multiple transitions between different teams for patients and had improved communication and joint working between the teams. Weekly project meetings monitored actions.

5th and 6th August 2015

During an inspection of Forensic inpatient or secure wards

This inspection was a follow up visit from a comprehensive inspection that was undertaken in October 2014. We do not rate services based on the outcome of a focused inspection. The ratings that were awarded at the time of the comprehensive inspection in October 2014 remain.

In summary we found the following:

  • Patients’ at both sites were not routinely having their observation levels and associated risks recorded within a plan of care, although (and with the exception of two patients with the pre discharge flat) the practice of completing observations of patients was being done.
  • The understanding of the differences between seclusion and de-escalation was not clear. The practice of providing bowls to patients for toileting purposes as opposed to appropriate facilities, when in seclusion, was of concern to us. We also found that the current design of the room did not allow for good, clear and effective communication between staff and patients’ held within the seclusion room at Southfields.
  • Nursing staff were not aware whether Flumazenil medicine was stored on the premises at Southfield. At both Ravenswood and Southfield, there was limited knowledge for the use of Flumazenil by registered nurses and whether it was stored on the premises or not.
  • That safety improvements to the environment at Ravenswood had begun, were on schedule, and were due to finish in February 2016.
  • Environmental assessments across both sites were being completed on an annual basis.
  • The Trust had implemented a programme of learning which involved showing staff how to use ligature cutters and how to correctly store and record ligature cutters.
  • Fridge temperature monitoring across both sites for the safe and effective storage of medicines was, on the whole, being completed.
  • The recruitment of Band 5 registered nurses remained a problem for the Trust, however, work continued within the Trust in order to address this.

7 to 10 October 2014

During a routine inspection

Southern Healthcare NHS Foundation Trust delivers a wide range of community health care, mental health, learning disability and adult social care services from many locations across a wide geographical area and whilst we found many areas of good practice and services, including some outstanding practice and services, there was a lack of consistency across the trust.

We rated community health services for children, young people and families, community mental health services for adults of working age, rehabilitation mental health services, community-based mental health services for older people and eating disorder services good across all five areas (safe, effective, caring, responsive and well-led). We rated perinatal services outstanding across all five areas. However, eating disorder services and perinatal services are not part of our core services suite so these ratings do not count towards the overall provider level rating. The rating for Urgent Care services also does not count toward the overall rating as this too is not one of the core services used in the aggregation of ratings. 

We found the trust had a clear vision, had developed a clear set of goals and values that most staff knew about and understood and these were gradually being embedded throughout the trust. There was evidence of good leadership and commitment from the board, the executive team and senior managers. We heard of many new initiatives and the trust was continually looking for ways to improve. However, it was clear that time was needed to fully realise the scale and complexity of the changes and embed these across the trust.

We gave an overall rating for the provider of requires improvement because:

  • The trust was in the process of redesigning the way it delivered its services. For example, the introduction of a new divisional structure, the implementation of a recovery focussed mental health pathway for adults of working age and the introduction of integrated physical health care and older adult's mental health teams which has been recognised nationally as a model of good practice. However, these changes were at a relatively early stage of development and were not fully embedded across the trust.
  • Although the trust board had been strengthened with the appointment of new non-executive directors and a number of new executive directors and clear lines of accountability and responsibility had been established, some executive directors had only recently taken up post. The director of nursing and allied health professionals had been in post four months so was still establishing her role and raising her profile so staff and stakeholders knew of her responsibilities and plans. In addition, a number of senior managers and clinical leaders had been appointed to support implementation of the changes but many of these had only been in post a short time.
  • As result of a review of governance arrangements undertaken by Deloitte on behalf of the trust, several changes had been made to the trust governance framework to strengthen its arrangements to maintain the oversight needed. However, many of these changes were at an early stage of implementation, including the introduction of a new board assurance framework (BAF) which had only been agreed at the board meeting held in September 2014.
  • Community health care services did not always have enough staff and the gaps were not always covered. This meant that in some community teams there were missed visits to patients and long waiting times for treatment by a therapist.
  • There were delays in the supply of equipment such as hospital beds or special mattresses for home use this meant that patients could be at increased risk of pressure ulcers.
  • The number of attendances at Lymington Minor Injuries Unit (MIU) had increased over the years and due to staff vacancies there were sometimes difficulties in covering shifts with the appropriate number of staff to provide a safe service.
  • We found insufficient numbers of specialist palliative care staff meaning that patients did not always get the right level of care at the end of their life.
  • There were issues with the management of medicines at both the MIU at Lymington Hospital and Petersfield Hospital. In the theatre suite at Lymington New Forest Hospital and Sultan ward at Gosport War Memorial Hospital the Controlled Drugs cupboards did not comply with the trust’s own policies and procedures. There was insecure management of FP10 prescription pads with an incomplete audit trail of safe and appropriate use. Patient Group Directives (PDG’s) for the administration of medication in both MIU’s had been removed by the trust in September 2014, as these were past the review date. The trust had identified that most Patient Group Directives (PDG’s) were past there review date and had initiated an action plan to resolve the situation. However, when we inspected the PGDs were not available for operational use at the Petersfield MIU.
  • In community health services and some inpatient services for adults there were unsatisfactory arrangements in place for the obtaining, recording, handling, using, safe keeping, dispensing, safe administration and disposal of medicines.
  • We were concerned about the trusts ability to provide safe care to patients at Ravenswood House as the building was unfit for the purpose for which it was being used. There were plans to renovate some wards in the short term and in the longer term, the service was to be moved to a new building and plans for this were being considered at the time of the inspection. 
  • We were concerned about ligature management at Ravenswood House, Southfields and in the seclusion room at Leigh House. Although the trust had a ligature minimisation programme risk assessments had not been carried out and staff showed a lack of understanding of how ligature risks should be managed. We asked the trust to take immediate action. The trust responded positively by making some immediate changes and by providing a clear action plan of how it would manage the risks in the future. However, many of the risks to patients at Ravenswood House remain due to nature of the building.
  • In some mental health services there was inappropriate seclusion and physical intervention practices due to a lack of suitably trained staff, policies that did not provide clear direction and some staff who lacked awareness of good practices.
  • Across mental health services there was inconsistent staffing levels and skill mix; wards were not always staffed to safer staffing levels. This significantly impacted upon the care and treatment to patients being delivered at the right time and in the right way. Staff reported working longer than their contracted hours in order to deliver care to patients and said that the dependency of patients was not taken into account when deciding the numbers of staff required. The trust was actively recruiting new staff and was closely monitoring staffing levels.
  • Patients expressed confusion and frustration about access to crisis services. Staff lacked clarity about how these services were provided and the policy was not clear. Staff told us that the acute mental health teams and hospital at home teams did not provide crisis services although this was the plan for the future and that community mental health teams (CMHTs) provided crisis services but only during office hours. Patients and carers, particularly those wishing to access services at Parklands Hospital, told us they were given a telephone number but when they called it was rarely answered. In addition, there was no crisis service for older people; the trust is not commissioned to provide these services.
  • Community mental health teams (CMHTs) often struggled to find an available bed locally for patients requiring admission to an acute mental health ward. This meant that patients were often accommodated in a hospital bed a long way from their home.
  • At both Antelope House and Elmelight Section 136 suites (health based place of safety) patients were not routinely examined by a doctor on admission to determine the presence of a mental illness. This resulted in long periods of detention for patients not suffering a mental illness. This contravenes the MHA Code of Practice. There was also long waits for assessments by an approved mental health professional meaning patients stayed in S136 suites for long periods of time.
  • The trust had reconfigured its learning disability services in Oxfordshire, closed inpatient services at Slade House and made several changes to improve services following an external review into a tragic death at Slade House. A special committee of the board was in place to oversee the turnaround of the services. However, staff, patients and carers still had concerns about on-going issues as they felt the trust had not been as open and honest as it could have been. It was clear this was impacting significantly on their welfare. The uncertainty about whether the trust would continue to deliver services in the future was affecting staff morale.
  • Information systems, particularly in community health services and mental health community services were preventing staff from delivering services as effectively as they would like; this was having an impact on care provided to service users as records were often not accessible. Staff were aware of plans to introduce new systems but were unaware of timescales for this.

However, care was delivered by kind, sensitive and caring staff that were passionate about their work and committed to delivering high quality services. Patients and their families told us that the majority of staff treated them with respect and dignity. Many of the staff we spoke with said they were proud to work for the trust, enjoyed their work, felt they had opportunities to develop professionally and felt the trust was generally moving in the right direction to bring about improvement in services. However, several commented that the pace of change was, at times, moving too quickly to embed the changes effectively.

One of the vehicles being used to achieve the trust vision and support key changes to improve services was the trusts leadership programme ‘going viral’, which was available to staff at different levels of management. A new strand of the programme was being developed for all staff. The trust had a clear commitment to investing in staff and was providing a wide range of training and learning opportunities that were appreciated by staff.

The new BAF identified a red, amber or green rating for high level, strategic risks which were mapped to the priority areas of the quality programme: quality governance structures in the divisions, reporting and organisational learning, peer reviews, estates readiness, record keeping and care planning, medicines management, workforce and patient experience. The trust had introduced an innovative information system which provided high quality performance data to allow the board to monitor its performance. This information was beginning to be used by the trust board to identify and monitor risks.

Alongside this, a number of initiatives had been introduced to support improvement, including peer review visits and local audits. These were not always identifying all poor practice so improvements were not being made in a timely manner. In addition, some issue were being identified but action was not always being taken in a timely manner or was not being taken so the opportunity to improve was being missed.

In all services we found evidence of care being delivered in accordance with evidence based guidelines and in line with recognised good practice with good examples of positive outcomes for people using services. We were impressed by the recovery college and perinatal services.

We visited all locations that cared for patients detained under the Mental Health Act and found that staff generally adhered to the requirements of the Act, including ensuring people received Section 17 leave (leave to go off the ward accompanied by staff). Some patients told us that at times they could not take Section 17 leave when they wanted due to staff not being available to support them. Seclusion and restraint practice in some areas contravened MHA Code of Practice. 

The trust had systems in place to safeguard people from abuse. Most staff we spoke with understood the importance of safeguarding vulnerable adults and children and knew how to raise an alert. It was also clear that staff were encouraged to report all types of incidents. There was evidence of learning from incidents and evidence of improvements being made as a result of reporting and sharing the outcomes of incidents. However, there were some areas were practice was inconsistent or not embedded.

The trust had a clear commitment to progressing research and had conducted 45 research studies between 2012/14 involving approximately 800 people. It had also won eight national awards for Equality and Diversity. We found a proactive approach to equality and diversity across the trust.

The trust had a range of patient groups and forums across several services which it encouraged patients to get involved in. The trust engaged with its stakeholders, including patients, people of all ages who used services and carers through 15 social media channels and had recently launched a listening App called Southern Health Listens. The trust offered a range of opportunities for patients to provide feedback about their experience of receiving care and we found that this this feedback was beginning to improve care throughout the trust.

It is our view that the provider had made significant progress in developing services and bringing about improvements and that given time, the provider would realise its vision and deliver good and outstanding services across the trust.  However, some significant work was still required to improve the quality and consistency of its services across the trust.

We found that the trust was in breach of a number of regulations. We will require the trust to meet the requirements of the regulations within a specified time period. However, we are not taking any enforcement action.

We will be working with the trust to agree an action plan to assist them in improving the standards of care and treatment.       

Intelligent Monitoring

We use our system of intelligent monitoring of indicators to direct our resources to where they are most needed. Our analysts have developed this monitoring to give our inspectors a clear picture of the areas of care that need to be followed up. Together with local information from partners and the public, this monitoring helps us to decide when, where and what to inspect.

Mental Health Act Commissioner reports

Each year, we visit all NHS trusts and independent providers who care for people whose rights are restricted under the Mental Health Act to monitor the care they provide and check that patients' rights are met. Immediate concerns raised by patients on those visits are discussed, if appropriate, with hospital staff.

Our Mental Health Act Commissioners may carry out a number of visits to each provider over a 12-month period, during which they talk to detained patients, staff and managers about how services are provided. In the past, we summarised themes from the visits and published an annual statement followed by the provider's response where applicable. We are looking at different ways to indicate the outcomes of our monitoring in the future.