Hampshire and Isle of Wight Healthcare NHS Foundation Trust

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

This means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

This is the first inspection for this service since the formation of the new trust. This key question has been rated requires improvement. We found 2 breaches of regulations in relation to person-centred care planning and reading people their rights under section 132 of the Mental Health Act.

Requires Improvement: This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

Care plans were not always present or current and did not always reflect actual needs and preferences. The service did not consistently follow legislation and current evidence-based good practice and standards. The service did not always work well across teams and services to support people. The service did not always routinely monitor people’s care and treatment to continuously improve it. The service did not always record consent to care and treatment. Staff did not always consider a person’s capacity to consent in line with the requirements of the Mental Capacity Act.

However, the service supported people to manage their health and wellbeing to maximise their independence, choice and control.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

Care plans were not always present or current. They did not always reflect actual needs and preferences, placing people at risk of care and treatment that did not meet their needs.

We reviewed 51 electronic care records and found 16 records had either no care plan or care plans which were not current. In some teams, a patient rated satisfaction scale was used as the only care plan, in others an additional person-centred care plan was produced.

We spoke to 41 people who used services, only 8 told us they were aware of their care plans and had copies.

Staff mostly completed a comprehensive mental health assessment for a person after their admission to the team. We saw this was completed in 33 out of 51 records we reviewed. We observed the initial triage calls to 2 people at the Isle of Wight Access to Intervention (A2I). Staff used a threshold for assessment tool following initial referral to indicate if a referral was routine or urgent. The triage calls we observed were holistic and person-centred and carried out by appropriately skilled and trained staff. Staff carried out a thorough bio-psycho-social triage and signposted people or referred them to an appropriate pathway.

The service did not consistently follow legislation and current evidence-based good practice and standards in relation to the Mental Health Act.

Staff provided a range of care and treatment interventions suitable for people who used services. The interventions delivered were in line with guidance from the National Institute for Health and Care Excellence (NICE). For example, people could access psychological treatments and interventions, such as dialectical behaviour therapy, cognitive behavioural therapy and acceptance and commitment therapy. There were also group interventions such as managing emotions, hearing voices and mindfulness for psychosis.

However, there was variation in the range of psychological interventions available across different divisions, with not all types of therapy available in all areas. Family intervention therapies were not available in all teams. Waiting lists for psychological therapy also impacted people’s access to suitable interventions.

Early intervention in psychosis (EIP) teams took part in the National Clinical Audit of Psychosis. The results of the last audit were prior to the formation of the trust.

The service did not audit compliance with ensuring that people who used services who were under a community treatment order (CTO) had their rights read to them as required by section 132 of the Mental Health Act (MHA). The service told us teams on the Isle of Wight had a reminder system to ensure they contacted people every 3 months. In Southampton and Hampshire, teams stated they filled in an incident report any time they missed reading someone their rights. We reviewed incidents reported in the last 12 months and saw 8 incidents were reported where someone was not read their rights, but it was not possible to see which team reported this. In Portsmouth, teams did not have a system to record if rights were being read, other than within the individual care record. Therefore, we could not be assured that people had their rights read in accordance with the MHA or that leaders and managers had oversight of this. Following our inspection, the service told us they received a regular report from the MHA administration team which highlighted when 132 rights were due or overdue.

The CTO policies for the legacy trusts were reviewed by the trust prior to the merger. The trust retained each legacy trust policy and provided staff with an overview document which included links to all the relevant policies. Compliance with the CTO policy was monitored through the trust’s mental health law governance structure. The service told us they planned a consultation with clinical teams to review the documents and develop a single CTO policy for the trust. However, there was no clear timeline for this work. The use of CTOs was monitored in the Mental Health Law Oversight Committee on a quarterly basis.

Not all staff completed mandatory training in the Mental Health Act. Training compliance varied between 91% and 10% across teams. In 26 out of 30 teams, compliance was below 75%, with compliance below 20% in New Forest East CMHT at 10%, Early Intervention Team west area at 15% and West Southampton CMHT and Southampton Assertive Outreach Team at 17%.

The service employed peer support workers who were collocated in some community or early intervention teams. In some CMHTs peer support workers were provided by contracts with the local voluntary sector. The peer support worker is identified as a key role in NHS England guidance ‘Implementing the early intervention in psychosis access and waiting time standard’ guidance February 2023. The trust had a peer support work group and was developing the model for management of peer support workers.

The service did not always work well across teams and services to support people.

Not all staff attended regular team business meetings. We requested minutes for team meetings for the last 3 months. The service provided these for some but not all teams. We reviewed minutes that were provided and saw there was no set agenda, and topics of discussion varied across divisions and teams.

Some staff told us arrangements for working with primary care providers were not always effective. This was because of a lack of staff in primary care teams which meant staff in CMHTs spent additional time liaising with GPs regarding referrals which did not meet the criteria for CMHT input.

We requested, but the service did not provide, evidence of regular MDT meetings and minutes. They told us they were not able to provide this due to the personal identifiable information within the minutes, but all teams had weekly MDT meetings.

We observed MDT meetings at Isle of Wight EIP team, Central and West CMHT and Access to Intervention team, Southampton Central CMHT and the Portsmouth Assessment to Intervention team. They were attended by all members of the MDT, and we saw staff worked well together. Staff described positive multidisciplinary team working, with good working relationships across different roles and grades.

The service took part in MADE events between July and August 2025 in Isle of Wight and Portsmouth and South East Hampshire divisions. MADE events bring together healthcare and social care partners to improve how patients are discharged from hospitals, aiming to unblock delays, simplify processes, and enhance patient flow through the system.

The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduce their future needs for care and support.

Staff supported people to live healthier lives. For example, EIP teams across the service developed relationships with external providers such as smoking cessation and substance use teams, weight management programmes and physical health services to encourage people to access physical health interventions. The EIP service was developing a booklet for people with details of their physical health check outcome and signposting to local and national organisations that may help improve their physical health.

The EIP service in the Isle of Wight division ran a gym group to support people to access free gym sessions. There was also a weekly walking group and a member of staff offered auricular acupuncture to people who used services. Auricular acupuncture is a therapy where fine needles are inserted into specific points on the outer ear to treat issues in the entire body.

At Portsmouth Recovery team staff could access smoking cessation support for people using services. Occupational therapists offered gym sessions and healthy eating groups.

We observed staff talking to people about their physical health, including diet and sleep health in appointments we observed.

The service did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

We requested any outcome measure audits the service had completed in the last 12 months. The service provided a report by Hampshire and Isle of Wight Integrated Care Board (ICB) which showed key outcome and demographic data for the service benchmarked against national figures. However, the data within in the report was for 2023 to 2024 which was prior to formation of the trust.

Tools to audit and improve the quality of the service were not robust, nor consistently used. They provided evidence of CMHTs in Mid and North Hampshire, Portsmouth and the South East Hampshire and Southampton and the South West Hampshire divisions’ quality assurance tool, which was completed bi-monthly. The tool had questions which related to key areas of the service. These were first impressions, environment, medicines management, physical health monitoring, record keeping, care planning and questions for staff. We reviewed the report for June 2025 however, 3 community mental health teams (CMHT) did not submit audit outcomes to this. The service told us use of the tool was under review, as it was inherited from one of the legacy trusts. The review was to assess if the tool was fit for purpose across all services and any improvements or changes required.

Teams on the Isle of Wight completed an online audit tool which had been in use since October 2024. The service told us work was still in progress to ensure all service leads and delegated administrators were registered and trained to use the system. They stated work to ensure audits were fit for purpose and effective was ongoing and led by the community mental health service leadership forum. We reviewed the action plans for audits completed between April and September 2025. Eight out of 29 actions had not been completed, there was no target date for completion in the action plan tracker and 10 showed as overdue. This included actions to improve care plan and risk assessment completion.

It was not clear from the information provided if both tools in use covered the same topic areas.

Staff in some divisions recorded outcomes in care records using a nationally recognised patient rated satisfaction scale. However, this was not used consistently across all teams. In some teams, this was used in place of a care plan, in others it was used separately, and in others it was not used at all. We saw this was used in 22 of 51 care records we reviewed.

The service did not always record consent to care and treatment. Staff did not always consider a person’s capacity to consent in line with the requirements of the Mental Capacity Act.

Staff did not always record consent to care and treatment in people’s records. We found consent was not recorded in 15 out of 51 records we reviewed.

However, we observed depot clinics where consent was gained and recorded in people’s care records before medicine was administered. We also saw consent to referrals and services was discussed in MDT meetings we observed. The service ensured people had access to independent advocacy services.

In care records we reviewed where capacity was documented for a person, this was in relation to insight into their diagnosis and illness and there was little evidence of decision-specific formal mental capacity assessments.

The trust audited compliance with the Mental Capacity Act (MCA) annually. We reviewed the audit for October to December 2024. The audit only looked at 9 records which were for people using psychology services and Talking Therapies. In all 9 records there was recorded evidence the person had a new or existing mental health disorder or impairment of the mind and practitioners had recorded this. In 5 out of the 9 records checked the practitioner had not clearly documented the capacity status of the person in relation to their ability to make a specific decision.

The service did not provide full information on staff compliance with MCA training. Mandatory training compliance data provided showed only 2 people eligible for the training, 1 each in Andover and Romsey CMHT. The trust’s internal MCA audit found their newly developed approach on training for MCA had not been standardised across the organisation and staff showed a lack of understanding with regards to the MCA. We were therefore not assured the service trained staff in the requirements of the MCA, nor monitored their awareness of these requirements.