Hampshire and Isle of Wight Healthcare NHS Foundation Trust

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We looked for evidence that people were protected from abuse and avoidable harm.

The wards at Antelope, Elmleigh, Melbury and Parklands were visited as part of an inspection in 2022. The acute mental health ward at St James was previously inspected in October 2018 under the previous provider, Solent NHS Trust. The acute mental health ward at St Mary's was previously inspected in July 2021 under the previous provider, Isle of Wight NHS Trust

We rated this key question as good because:

All wards were safe, clean well equipped, well furnished, well maintained and fit for purpose.

Staff assessed and managed risks to patients and themselves well.

Staff understood how to protect patients from abuse and the service worked well with other agencies to do so.

The service used systems and processes to safely prescribe, administer, record and store medicines.

The service managed patient safety incidents well.

However:

There were inconsistencies about incident reporting and learning from incidents across the trust. For example, some wards did not share learning from incidents amongst all staff.

This service scored 69 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We scored the service as 2. The evidence showed some shortfalls.

The service did not always have a proactive and positive culture of safety based on openness and honesty.

They did not always listen to concerns about safety and did not always investigate and report safety events.

Lessons were not always learnt to continually identify and embed good practice.

The number of incidents reported and recorded varied across the different wards. Antelope House and Parklands had higher levels of incidents recorded. These tended to be the wards with highest patient turnover and occupancy. Incidents were not always reviewed promptly and learning was not always shared across the service promptly.

There was an inconsistent approach to reporting, recording and managing incidents. For example, some wards had long gaps between incidents occurring and recording them.

Staff did not always receive feedback on incidents or meet to discuss incidents. For example, staff not on duty for debriefs following incidents missed information being shared

However, staff understood what incidents to report and how to report them. At Melbury Lodge there was evidence of good practice where learning from an incident had resulted in a quality improvement project to reduce medicine errors.

Senior managers debriefed staff after all serious incidents.

Quality Statement Score: 3

We scored the service as 3. The evidence showed a good standard.

The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored.

They made sure there was continuity of care, including when people moved between different services.

The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. Each ward had referral and admission processes which ensured that all essential information about the patient was received to determine if staff could safely meet the patient’s needs. Staff were able to decline an admission if they felt unable to safely meet that patient’s needs.

They made sure there was continuity of care, including when people moved between different services. Staff involved all the necessary healthcare and social care services to ensure patients had continuity of safe care, both within the service and post-discharge. There was evidence of integrated pathways with community services pre and post discharge.

Quality Statement Score:3

3. We scored the service as 3. The evidence showed a good standard.

The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that.

They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately.

Staff were trained in safeguarding, knew how to make a safeguarding alert, and did this when appropriate. We saw evidence of relevant safeguarding referrals and working with the Local Authority including Section 42 safeguarding inquiries.

Staff knew how to identify adults and children at risk of, or suffering, significant harm. This included working in partnership with other agencies. Staff could give examples of how to protect patients from harassment and discrimination, including those with protected characteristics under the Equality Act.

Each service had a dedicated safeguarding lead and staff knew who they were.

Staff only used restraint, restrictive practice and blanket restrictions as a last resort. We observed evidence of staff using de-escalation strategies before using physical restraints.

.Restrictions that had been put in place were regularly reviewed by staff to ensure they were still necessary. Each ward had a blanket restrictions log which was reviewed regularly and discussed at patient meetings.

Quality Statement Score 3

3. We scored the service as 3. The evidence showed a good standard.

The service worked with people to understand and manage risks by thinking holistically.

Staff assessed and managed risks to patients and themselves well and 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.

They provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

We looked at risk assessments and reviews across all the wards. We found a variation in the level of detail recorded and the quality of care plans developed from these risk assessments. For example, care plans at Parklands and Antelope house lacked detail and were generic in nature.

Staff involved patients in care planning and risk assessment including regular reviews and sharing copies of care plans.

Staff communicated with patients so that they understood their care and treatment, including finding effective ways to communicate with patients who had communication difficulties. For example, using easy read symbols.

Staff enabled patients to give feedback on the service they received via community meetings held on the wards. Some wards had a 'you said, we did' board where patients could share suggestions for improving life on the ward.

Staff enabled patients to make advance decisions when appropriate. For example, patients wishes regarding future physical health care.

Staff ensured that patients could access advocacy. We spoke with independent advocacy staff on 3 wards and they felt part of the ward team and listened to by the staff.

The Independent Mental Health Advocates (IMHA) felt they were being used appropriately and people were being referred to them.

Staff ensured that patients could access Independent Mental Health Advocates (IMHA). We spoke with IMHA’s on 3 wards and they felt part of the ward team and listened to by the staff. They felt staff were referring people to their service appropriately.

The service did not always detect and control potential risks in the care environment.

They did not always make sure equipment, facilities and technology supported the delivery of safe care.

Staff did regular risk assessments of the care environment including ligature risk assessments. Problems had previously been reported by the provider about potential ligature risks in the bathrooms across several of the wards at Parklands and Antelope House. A ligature describes any material that can be used to tie or bind something tightly and can be used as a form of self harm by tying around the neck and attaching to a point.

However, there was no action taken to reduce these risks and staff said they had been reported.

Osbourne ward, on the Isle of Wight, and The Hawthorns, in Portsmouth, were mixed sex wards all the other wards were single sex. Both of these wards had single sex corridors for bedrooms and female only lounge areas.

Staff had easy access to alarms and patients had easy access to nurse call systems.

Staff could easily observe patients in seclusion and patients could use a two-way communication system and easily access a toilet whilst in seclusion. However, the seclusion suite on Cherry ward at Parklands did not have a clock, which was not in line with the requirement outlined in the Mental Health Act 1983 Code of Practice.

Clinic rooms were not fully equipped with accessible resuscitation equipment and emergency drugs that staff checked regularly.

We saw evidence of opened emergency bags at Parklands and Antelope House where equipment had been used in an emergency and not replaced. We raised this during the inspection and were told bags were restocked by an external company and not by staff on site. Staff had to report the bags had been opened to the external company.

One of the bags at Antelope House had been missing equipment for 2 weeks at the time of the inspection. This was escalated and the bag contents were replaced during the same week as the inspection. Staff should have ensured bags were checked and reported daily to get stock replaced as soon as it was used.

At Sevenacres, the wards had a resus trolley and cardiac arrest drugs bricks that were checked daily. The ward are able to restock themselves, utilising stock from the local acute Trust rather than the external company used by the Hampshire-based wards"

We scored the service as 3. The evidence showed a good standard. The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

The registered nurse vacancy rate in March 2025 was 18%. However, we identified instances where there were no permanent staff working. On 7 occasions during March 2025 on Abbey ward at Antelope House, no permanent staff were rostered to work at night There were 3 occasions on Juniper ward at Parklands hospital where no permanent staff had been rostered to work at night. This related to both registered nurses and healthcare assistants all being temporary staff with shifts filled by bank and agency workers.

There had been considerable recruitment by the provider across all wards since the last inspection. This meant the number of regular staff had increased and there was less reliance on bank and agency staff to fill shifts.

Managers had calculated the number and grade of nurses and healthcare assistants required.

The number of nurses and healthcare assistants matched this number on all shifts.

The ward manager could adjust staffing levels daily to take account of case mix.

When necessary, managers deployed agency and bank nursing staff to maintain safe staffing levels.

When agency and bank nursing staff were used, those staff received an induction and were familiar with the ward.

A qualified nurse was present in communal areas of the ward at all times. However, some wards for example Hawthorns and Ruby ward were large and difficult to cover with staff in all areas. However, staff ensured hourly checks took place of all ward areas.

Staffing levels allowed patients to have regular one-to-one time with their named nurse.

Staff shortages rarely resulted in staff cancelling escorted leave or ward activities. However, this varied across wards and occasionally activities and leave were cancelled when the ward was particularly busy.

There were enough staff to carry out physical interventions, for example, observations, restraint and seclusion safely and staff had been trained to do so.

There was adequate medical cover day and night and a doctor could attend the ward quickly in an emergency. The medical cover varied across the wards and all had contingency plans for physical health care and the deteriorating patient pathway.

Staff had received and were up to date with appropriate mandatory training and training was appropriate for the patient group using the service.

3. We scored the service as 3. The evidence showed a good standard. The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

Staff maintained equipment well and kept it clean. Any ‘clean’ stickers were visible and in date.

All ward areas were clean, had good furnishings and were well-maintained. We saw evidence of cleaners working across all wards.

Cleaning records were up to date and demonstrated that the ward areas were cleaned regularly.

Staff adhered to infection control principles, including handwashing. We saw evidence of staff using appropriate personal protective equipment (PPE) when carrying out personal care.

Quality Statement Score:3

3. We scored the service as 3. The evidence showed a good standard.

The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences.

They involved people in planning, including when changes happened.

Staff demonstrated good practice in medicines management in line with national guidance.

Staff reviewed the effects of medication on patients’ physical health regularly and in line with NICE guidance. We saw that staff monitored patients who were prescribed high dose of antipsychotic medication (HDAT) in line with current guidance. The electronic prescription system identified any patients on HDAT. Staff followed the trusts policies for prescribing medications such as Lithium and Clozapine which include the appropriate physical health checks are completed. For example, regular blood tests.

We reviewed the management of controlled drugs and saw that staff followed the trust policy which included daily stock checks by 2 members of staff and all wards had destruction kits on site.