• Organisation
  • SERVICE PROVIDER

Mersey Care NHS Foundation Trust

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

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

All Inspections

15 October 2019

During an inspection of Wards for people with a learning disability or autism

We plan our inspections based on everything we know about services, including whether they appear to be getting better or worse.

This inspection report is solely about The Breightmet Centre for Autism in the Bolton area of Greater Manchester. Services were provided as an independent hospital by ASC Healthcare Limited. We inspected the hospital under that management on 14 and 20 June and on 14 July 2019. We had serious concerns about the quality of care and the safety of patients so we removed this location from the company's registration on 16 July. On 19 July Mersey Care NHS Foundation Trust took over responsibility for services at the centre temporarily to provide a safe environment for the patients.

ASC Healthcare Limited successfully appealed against the removal of the location and ASC Healthcare Limited resumed as the registered provider from 4 November 2019. 

This report relates to an inspection carried out while The Breightmet Centre was a location of Mersey Care NHS Foundation Trust prior to ASC Healthcare Limited's successful appeal.

We conducted an unannounced focused inspection on 15 October 2019 to check that patients still remaining at the centre were safe and that the service was well led. We looked only at the safe and well led key questions. We did not rate services at the centre.

At the time of the inspection the centre was registered to provide:

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

The centre has 18 beds for men and women with learning disabilities and/or autism. At the time of our inspection, there were seven patients, both men and women, still at the location.

We found that since our previous inspection there had been significant improvements in the quality of care and the care environment, making it safe for the remaining patients. The leadership being provided by Mersey Care was effective and included dealing with some urgent health and safety issues.

30 Oct to 20 Dec 2018

During an inspection of Community health services for adults

This is the first time we rated this service and we rated it as requires improvement. We rated it as requires improvement because:

  • The service did not always have the right number of staff although staff had the right qualifications, skills, training and experience to keep people safe from avoidable harm and abuse to provide the right care and treatment.
  • There was a lack of clinical supervision in some services and competency based training was not always carried out.
  • Some equipment necessary for carrying out treatments was not always available.
  • Controlled medications were not always destroyed and disposed of in line with Trust policy and procedures.
  • A number of Trust policies and procedures were out of date.
  • Some staff told us that there was a lack of visibility of senior and middle management.
  • Some staff told us that they were reluctant to speak up to the ‘freedom to speak up champions’ due to previous experiences.

However:

  • The Trust planned and provided services in a way that met the needs of local people and worked well with external organisations.
  • The service primarily used electronic patient records. Patient records were easily accessible by staff working in all community teams. Staff could access records using electronic devices in patient home and on computers based in clinic areas.
  • Records were clear, legible and information collated was in chronological order.
  • Staff from different specialities worked together collaboratively to benefit patients and their families.
  • The service controlled infection risk well and infection rates were low.
  • The service managed incidents well. Staff recognised incidents and reported them appropriately. There was a positive culture around the reporting of incidents and lessons learnt were shared with the whole team.
  • The service provided care and treatment based on national guidance and evidence based care.
  • The service had a clear vision and strategy in place. The service knew what it wanted to achieve and workable plans to turn it into action.

20 March 2017 to 23 March 2017

During an inspection of High secure hospitals

We rated high secure services at Ashworth Hospital as good because :

  • Wards were clean and well furnished. Mirrors and closed circuit television cameras were used to ensure that patients and staff were safe and monitored on every ward. Staffing was being managed by ward managers and matrons, using a safe staffing system, and we were informed that 53 new staff had been recruited to the trust and would soon be ready to join the teams. National policies relating to night time confinement and long term segregation were being followed. Medication management followed guidance, and the introduction of an electronic prescription system had improved monitoring. Incidents were reported and appropriate actions were taken to deal with these incidents.

  • Care plans were comprehensive and holistic across the service. Staff involved patients in the development of their care plans and gave copies of care plans to patients when the patient agreed to accept them. Staff were able to access further specialist training from external bodies, up to and including masters level qualifications. The care records indicated that staff paid as much attention to patients’ physical healthcare as they did to patients’ mental health. The provider had recruited psychologists to the service.This improved the patients’ access to effective psychological therapies. All patients were detained under the Mental Health Act.Staff across the service adhered to the guidance in the Mental Health Act Code of Practice. However, the trust Mental Health Act policy referred to an out of date Code of Practice; the trust was using the current Code of Practice. The Mental Capacity Act was applied across the service, and we saw evidence of capacity assessments in care records.

  • Interaction between patients and staff was seen to be of a high standard, empathic and professional. Patients told us that staff treated them with kindness and respect. We observed a patient forum and saw excellent interaction between staff and patient representatives, with matters discussed openly and with due consideration for all. We spoke with carers of patients and were told that, generally, they were positive about the service. Some carers raised points that we looked further into, and were assured that the service was acting in the best interest of patients. Patient viewpoints were listened to and helped to define the service.

  • The service was adhering to national recommendations regarding times for referral and assessment of patients. Wards were updated and refurbished on a rolling basis, as older wards were redecorated and improved. Forster ward had recently closed and re-opened as Newman ward, the new ward being appreciatively more modern than the old ward. The service had plans in place for patients from different cultures and countries, considering food, treatment and religious aspects.

  • The trust visions and values were embedded in the service. All staff knew of the values of the trust, and the direction the trust wanted to move. We saw evidence of senior staff involvement in the service, including at chief executive level. Staff were involved in clinical audit; the service itself had been involved in a number of audits in the 12 months prior to the inspection. Ward managers felt they had the authority to do their job. Staff told us that morale on the ward was quite high, but it would improve more when new staff joined the teams.

20, 21, 22, 23 and 31 March 2017

During an inspection of Forensic inpatient or secure wards

We rated forensic inpatient/secure wards (medium and low secure) as good because:

  • All wards had a ligature risk assessment in place. Security procedures that were in place for accessing the wards met the needs of each individual service and the level of security required.
  • Clinic rooms were functional; medical devices were checked regularly and serviced and calibrated annually. Physical health was monitored routinely, and patients had access to a GP twice weekly if this was required.
  • Risk assessments and care plans were in place for all patients. These were up to date and reflected the patients’ needs. The majority of patients told us that they had been offered a copy of their care plans.
  • Incidents were reported through the trust’s electronic incident reporting system. Staff received feedback on incidents and complaints through staff meetings and quality practice alerts.
  • Staff used National Institute for Health and Care Excellence guidance to guide their practice, and used recognised rating scales to monitor patient outcomes.
  • Staff received supervision and annual work performance appraisals. Staff felt skilled and competent to perform their role and had lots of opportunity for additional training should they wish to develop their skills further.
  • We observed positive and supportive interactions between patients and staff, which showed that staff treated patients with dignity and respect. Patients told us that staff were respectful and caring.
  • The independent mental health advocate was available on thewards, and supported patients in ward rounds and with their concerns. Community meetings took place monthly.
  • A referrals meeting took place weekly across the medium and low secure wards to review all referral, discharges and movements between the services.
  • Both diversionary and occupational activities took place on the ward seven days a week. The majority of patients told us that the food was good, and they had access to hot and cold drinks throughout the day and could have snacks. Both units had a multi faith room and could access spiritual leaders to support their patients’ cultural and spiritual needs. There was disabled access on both sites.
  • Staff were aware of the vision and values of the organisation. Staff felt that there was a high presence of the matrons within the low and medium secure services.
  • There were good governance systems in place for monitoring compliance with staffing sickness, mandatory training and appraisals. The ward managers felt that they had enough authority to perform their role and had access to key performance indicators, which helped to monitor the performance of their teams.
  • Staff morale was good and there was evidence of good team working. Staff were able to provide feedback on their services through team meetings. They were also invited to send any feedback to the trust chief executive.
  • All the wards were part of the quality network for forensic mental health peer review initiative.

However:

  • At the Scott Clinic, the sluice on four of the wards was located within the patient laundry room. This did not apply good infection control principles for clean and dirty areas.
  • Patients that were secluded at the Scott Clinic could potentially see the computer screens in the staff office which could cause a breach of confidentiality.
  • The ward staffing levels meant there were not always enough staff on duty to meet the needs of the patients; patients and staff told us that leave often had to be rescheduled.
  • The drug detection dog attended all the wards on a frequent basis. We felt that this practice was overly restrictive on low secure wards.

01 June – 05 June 2015 16th & 17th June 2015

During a routine inspection

We found that the provider was performing at a level which led to an overall rating of good.

The trust was well led and had some exceptional leaders, managing in very challenging circumstances. The board was highly aspirational and committed to delivering services which were of high quality and where every person matters. It was clear that most staff across the organisation understood, and were committed to, the vision and values of the organisation. These were well communicated and the work to win both hearts and minds was apparent. For instance, staff at all levels of the organisation were able to clearly articulate the drive for zero tolerance to suicide and understood the no force first initiative.

The trust had new ways of working, such as peer support models and recovery colleges. We saw good evidence of involvement across both corporate and frontline services such as the service user assembly and the commitment by the trust to involve experts by experience in all recruitment drives.

Key stakeholders, including the clinical commissioning gropus and local authorities, were positive about the trust and relationships were transparent, open and honest, with a good degree of challenge. This was also true of the relationships at board level. We concluded that the board worked well together and were professional and respectful in their interactions. They were able to offer high challenge, without rancour or defensiveness. They were passionate about people and committed to understanding, first and foremost, the lived ‘experience’ of people who use services.

The trust had good systems in place which helped them understand what was happening on the frontline. These systems helped them respond quickly and efficiently to areas of concern. For example; a weekly surveillance meeting, led by the chief executive, identified ‘hotspots’. This may be where incidents had occurred, or where a complaint had been made, or where data was showing the potential for risk. Action plans were developed immediately and directors tasked to go back into the service and deliver on assigned tasks.

Alerts were sent out across services called ‘quality practice alerts’. These enabled other services to learn from serious incidents and complaints. It was expected that actions arising from this learning was disseminated across services.

The trust had good monitoring systems for assessing safety and quality through its Governance of Quality Framework. This had resulted in identifying very clearly those services, which require improvement and had detailed actions in place to address any areas of risk or concern.

The process for monitoring of risk was robust and the board were clearly sighted on both the corporate and operational risks facing the organisation. These were presented in board meetings via a risk register.

The structure of meetings and committees, which provide the board with assurance, were well embedded. Most had non-executive director oversight. This ensured that the trust have leaders who are more objective and were well placed, to provide the appropriate challenge.

We found the trust had the right policies in place to support staff in their work and that staff received relevant training and support. An exception to this was the Rathbone unit, where staff had not completed mandatory training, had not been adequately supervised or received an appraisal. There were gaps in staff understanding and application of the Mental Capacity Act and Deprivation of Liberty Safeguards in some teams. A requirement notice has been issued for the inpatient learning disability service, due to failure to ensure that documentation on capacity and consent to treatment and best interest decisions is completed.

We found that across the trust morale of psychologists’ was low and there was a lack of psychological support for people. We were pleased to see the trust had recently appointed a Head of Psychology. However, there were considerable access problems across the services in relation to psychological therapy and the trust have been issued with a requirement notice in this respect.

We found significant concerns in relation to one of the older peoples’ inpatient services and requirement notices have been put in place. These specifically relate to ensuring the dignity of patients is preserved. We were also concerned that Irwell ward was not a safe environment in relation to lay out of the ward and the use of glass doors and large glass reflective windows. Staff did not always meet the communication needs of individuals and during meal times food was not presented in an acceptable manner, for instance wrapped sandwiches were left on a table for patients to help themselves.

In forensic services there were concerns raised relating to some seclusion rooms which were not fit for purpose and did not comply with the Mental Health Act Code of Practice. The Trust responded immediately to our concerns and closed two seclusion rooms.

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.