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Provider: Hertfordshire Partnership University NHS Foundation Trust Good

We are carrying out checks on locations registered by this provider. We will publish the reports when our checks are complete.

Inspection Summary


Overall summary & rating

Good

Updated 25 April 2018

  • We rated safe as requires improvement and effective, caring, responsive and well-led as good. In rating the trust, we took into account the previous ratings of the seven services not inspected this time. We rated the trust overall for well-led as good. At this inspection, we rated two core services as outstanding, one core service as good and one as requires improvement. In rating the trust, we took into account the previous ratings of the seven services not inspected this time. Therefore, two of the trust’s 11 services are rated as outstanding, eight as good and one as requires improvement.
  • Staff showed caring, compassionate attitudes, were proud to work for the trust, and were dedicated to their roles. We were impressed by the way all staff in the trust embraced and modelled the values. The values were embedded in the services we visited and staff showed the values in their day-to-day work.
  • Staff managed medicines safely in most services. The trust had made improvements in medicines management since the last inspection. Documentation was clear, staff completed competency assessments, and managers implemented systems to manage medication and completed regular audits.
  • The trust provided mandatory training, supervision and appraisal. Staff compliance with this in most services was above 75%. Managers discussed the values with staff in supervision, and based team objectives on trust values. Senior staff saw leadership as fundamental to their role and managers were visible and approachable. The trust recognised staff success through individual and team awards and staff were encouraged and supported to develop in their roles.
  • Staff completed comprehensive and robust risk assessments and documentation showed clear patient involvement and inclusion. Care of patients focused on their strengths and areas of independence. Staff responded quickly and effectively to the changing needs of patients. Bed management processes were effective and embedded into some services.
  • Staff included patients in service improvement, using their feedback to change practice. We saw many examples of innovation and projects that had been trialled and then implemented in the trust.
  • Safeguarding and incident reporting were transparent locally and thorough; review and evaluation of this was proactive. Teams shared lessons learnt effectively and in some services shared this learning with patients. There was good evidence of multidisciplinary team working within the services and with external agencies.
  • Local leadership across the majority of services was strong, visible and effective. Senior leaders were known to staff and visited services. The board encouraged feedback from all levels of the organisation. The responsiveness of the teams and at board level to issues raised during the inspection was immediate.
  • The trust had a robust governance framework and structure. Service managers attended local monthly clinical governance meetings, which fed into the trust wider governance meetings. Local governance meetings discussed ward issues, such as incidents, safeguarding, staffing concerns, and identified and shared learning from incidents.
  • Information technology systems and use of technology applications enabled staff to deliver care more safely and efficiently. Quality improvement initiatives had begun to make a difference. The system for agreeing projects to be supported showed commitment to the principles the trust upheld. Staff involved service users in project decision that needed to be made.
  • A system called SPIKE gave staff access to monitor performance and leaders saw this as a way to assist data collection and analysis and reduced time on administration tasks. The trust was developing a second version of SPIKE to further improve data management and staff saw this as positive.
  • We were provided with a good description of the way in which the trust implemented Duty of Candour, highlighting that it is in the terms of reference for the investigation of each serious incident that the duty of candour is complied with; patients are contacted before, as part of, and at the conclusion of each investigation.

However:

  • Low staffing in the child and adolescent mental health ward may have impacted on the frequency of one to one keyworker sessions. In one ward for people with a learning disability or autism, shifts were not always covered with sufficient staff.
  • Although staff on the mental health wards had assessed the risks posed by potential ligature anchor points, they had not identified all such risks. Also they had not taken action to fully mitigate the risks posed by some of the potential ligature anchor points that they had identified. The trust took immediate action at the time of inspection to address this and a plan of works was completed by the end of January 2018.
  • We identified the use of restrictive practices on the child and adolescent mental health ward. Patients access to mobile phones was restricted and some patients were not allowed full access to the ward garden.
  • Seclusion occurred outside of designated seclusion rooms in several services and staff did not always clearly document the reasons for this. Two seclusion rooms had environmental issues identified and were not compliant with the Mental Health Act code of practice. The trust took immediate action to address this.
  • Some physical healthcare records lacked detail in care plans and monitoring for long-term health conditions did not take place.
  • Supervision compliance was low in two services. Most services had local system to record compliance in the absence of a trust wide system.
  • In one service, staff did not feel supported by senior managers and there was a poor working relationship with the education team. The leadership in Albany Lodge was new, the staff team was new and staff felt there was a lack of direction.
  • The trust did not follow the NHS framework for reporting serious incidents.
Inspection areas

Safe

Requires improvement

Updated 25 April 2018

  • We found ligature points on five wards that managers had not identified. There were no plans in place to reduce or mitigate the risk these posed to patients. The trust took immediate action at the time of inspection to address this and a plan of works was completed by the end of January 2018.
  • There were blind spots on two wards, which managers had not identified. Risks were partially mitigated through individual risk assessments.
  • Some staff observations did not maintain the privacy and the dignity of patients in the child and adolescent mental health ward.
  • Staff used restrictive interventions in the child and adolescent mental health ward in relation to mobile phones and garden access.
  • Two seclusion rooms did not meet the Mental Health Act code of practice and staff did not always complete timely medical reviews of patients in seclusion. In some services staff secluded patients in their bedrooms, ensuites, de-escalation rooms or a lounge and staff did not clearly document the reason for this.
  • We were not assured the wards had sufficient seclusion facilities to manage the behaviour of the patients. The trust took action to address the environmental issues in the seclusion rooms when we raised this.
  • Low staffing in the child and adolescent mental health ward may have impacted on the frequency of one to one keyworker sessions.
  • The management of medication was not robust at Lexden Hospital and three acute wards for adults of working age. At Warren Court, we found one eye drop medication with an expiry date of October 2017, which was still in use.
  • Some ward areas at Warren Court were not visibly clean. Some hand wash containers had been removed from the patient toilets. Some furnishings were worn. There was furniture and furnishings missing from some bedrooms.

However:

  • The majority of ward areas were clean, tidy and well maintained. We observed staff following infection control procedures, including handwashing.
  • Managers told us they could increase staffing as required.
  • Services used recognised risk assessment tools. Staff had completed personalised, holistic, recovery focused risk assessments for patients on admission in all wards. Staff were able to identify and respond to changing risks and updated patient risk assessments following incidents.
  • Managers and staff demonstrated good understanding of safeguarding, reporting, and recording incidents and escalated concerns immediately. Managers shared learning from incidents across the trust and disseminated this through team meetings on all wards. As a result of post incident analysis and learning from incidents, practice changed.
  • All wards had fully equipped clinic rooms with accessible resuscitation equipment and emergency drugs.
  • Managers ensured that staff received the necessary specialist training for their roles. Mandatory training compliance was 83%.
  • Restraint was used as a last resort when all other de-escalation techniques had failed.

Effective

Good

Updated 25 April 2018

  • Staff across the services received regular supervision and annual appraisals. Staff received mandatory training and induction, and a buddy system was in place for new starters.
  • Staff had knowledge of the Mental Health Act and Mental Capacity Act and applied the principles well in their work. Staff explained rights under the Mental Health Act to patients, regularly and in a way that they understood. Staff ensured patients were able to take their Section 17 leave as agreed. Instances of staff cancelling leave were rare. Staff knew how to access support and advice on Mental Health Act and Mental capacity Act issues.
  • Staff developed comprehensive care plans that met the needs of the individual patient, were up to date, personalised, holistic and recovery orientated. Staff carried out annual physical health checks and checks of physical health at regular intervals. We observed within patient notes, staff documented physical health checks.
  • Staff held daily multidisciplinary meetings. Patients, carers and commissioners were invited regularly to multidisciplinary team meetings.
  • Teams worked closely with external parties, such as social services, GPs and other service providers.
  • Most services had a full range of mental health disciplines and workers who provided input into patient care.

However:

  • On acute wards for adults of working age and psychiatric intensive care ward, staff did not complete physical health assessments or physical health care plans for all patients. Managers did not ensure staff received regular supervision. Staff told us that the psychological input was limited and did not meet the needs of patients. However, the trust showed us evidence that it provided a psychology service to these wards in line with its policy.
  • Staff on the child and adolescent mental health ward did not actively encourage patients’ participation in activities. Eating plans for those with an eating disorder did not have input from a dietitian.

Caring

Good

Updated 25 April 2018

  • Staff behaved in a kind, respectful and compassionate manner when interacting with patients. Staff responded to patients’ needs in a discreet and respectful manner. Staff always took time to listen to patients and fully understood what support the patient required, with a few exceptions.
  • Patients could give feedback on the service they received. The wards held regular meetings with full patient involvement and patient representatives attended governance meetings. Staff and managers told us that patients were involved in recruitment, service development and were active in planning their care. Staff held patients at the centre of everything they did, which showed the trust values were embedded in staff behaviours with patients. Staff and patients co-produced projects and we saw many examples where patients were at the centre of the trust’s activities.
  • Staff consistently informed and involved families and carers with the patient’s consent. We observed ward rounds where family members attended and staff supported them to be involved. Carers forums and patient involvement meetings were common practice within the services. Carers we spoke with told us that staff always treated them with high levels of respect and kindness and kept them up to date about their relatives care and treatment.
  • Patients were able to give feedback about their care, and staff supported them to raise a complaint about any aspect of their care. Staff received many compliments from patients about how staff treated them.
  • Advocacy support was available to all patients; advocates attended care programme approach and multidisciplinary meetings with the patient.
  • Advance decisions were in place where appropriate.

However:

  • On acute wards for adults of working age and PICU wards, not all patients had been offered a care plan.
  • On the child and adolescent mental health ward, patients and family we spoke with fed back on the poor attitude of some night staff.

Responsive

Good

Updated 25 April 2018

Our rating of responsive stayed the same. We rated it as good because:

  • Services managed bed numbers and transfers well. Staff supported patients during referrals and transfers by escorting them to visit other services and providing advice, information and reassurance during the transfer period. Staff managed smooth discharge and transfers of care. Staff involved community teams to support this process. Teams discussed discharge plans in patient ward rounds. External providers attended some of the wards and encouraged patients to participate in groups they facilitated in the community.
  • Staff and patients across all services had access to a full range of rooms to support care and treatment.
  • Staff supported patients to maintain contact with their families and carers. Wards had quiet areas for patients and rooms either on or off the ward where they could meet visitors.
  • A multi faith chaplain visited the wards regularly and attended community meetings. Wards had dedicated multi faith rooms or quiet rooms for patients to use. Staff provided religious texts to patients on request.
  • Most patients told us they knew how to complain. Staff encouraged patients to raise concerns in weekly community meetings and supported by staff to identify their own solutions. Staff knew how to record and escalate complaints. Managers investigated local complaints in a timely way and involved patients to feedback learning from complaints.
  • In most services, patients had access to information leaflets in a variety of languages and there was access to a translation service. Where required, staff knew how to access additional information that was not readily available in services.
  • There were activities across the week for patients, including weekends. There was appropriate access to spiritual support. Patients had access to drinks and snacks throughout the day.

However:

  • All acute wards for adults of working age and PICU wards reported high bed occupancies.
  • In two services, patients told us they did not have access to hot drinks and snacks all the time.

In the child and adolescent mental health ward, there was no designated private space for patients to make phone calls. Patients and staff we spoke with reported that the quality of the food was poor. There were no visible posters or leaflets in communal areas advising how to make a complaint.

Well-led

Good

Updated 25 April 2018

  • We were impressed by the extent that the values of the trust have been embraced by everyone and were shown and modelled by all of the staff we met. Staff challenged behaviours in each other when necessary. The trust values were embedded in the services we visited. Staff described the trust’s vision and values. Staff showed the values in their day-to-day work, showed kindness, respect and a very caring attitude towards patients, carers, visitors and each other. Managers discussed the values with staff in supervision and based their team objectives on these values. Interviews for new staff were values based and there was a culture within the trust to challenge those directly who did not demonstrate the values.
  • Senior staff saw leadership as fundamental to their role and we saw the trust embrace leadership values as being important at all levels of the organisation. Senior managers were very visible in core services and many members of staff told us that the board members were approachable and willing to hear comments. Managers were visible and approachable. The trust supported team leaders to develop their leadership skills. Leadership training was available for all staff through acting up opportunities, shadowing and mentorship. The trust provided staff with opportunities for career progression. The trust recognised staff success through individual staff and team awards. Staff were encouraged and supported to develop, and attend training for their roles.
  • The trust had a robust governance framework and structure. Service managers attended local monthly clinical governance meetings, which fed into the trust wider governance meetings. Local governance meetings discussed ward issues, such as incidents, safeguarding, staffing concerns, and identified and shared learning from incidents. Managers fed this learning back to front line staff and patients through team meetings, which patients attended.
  • Staff maintained a risk register at ward level. Staff were able to escalate concerns and submit items to the trust risk register. Senior trust staff reviewed the trust risk register and non-executive directors openly challenged issues, which the board welcomed.
  • Clinical leads had oversight of safeguarding and incident reporting and shared lessons learnt. Staff had implemented recommendations from reviews of deaths, incidents, complaints and safeguarding alerts at the service level. Each service fed into the trusts governance meetings, which then led into board meetings.
  • Compliance with mandatory training, supervision and appraisal was good. Managers supported all levels of staff to attend training relevant to their roles and develop their skills and knowledge and progress in their careers.
  • Patients and carers were able to feedback about the service using feedback forms. The trust collated this feedback and produced quarterly reports. Managers discussed feedback in team meetings and developed action plans to address any areas for improvement.
  • Managers proactively engaged patients and carers at various forums and in service developments. The trust encouraged staff to submit ideas for service development and quality improvement. The trust had a view that ideas from all levels of staff and patients could influence better service delivery and were heard and discussed. Service users were included in meaningful ways throughout the decision making processes in the trust to an impressive extent.
  • Despite some challenging geography, much had been done to ensure that trust leaders were visible and supported staff everywhere. Staff from services that were furthest away from the centre were encouraged to take part in meetings with others to encourage inclusion.
  • We were struck by the incidences shared with us that showed staff and leaders caring and supporting each other. The executive group shared a large office which increased informal learning, support and cross-generation of ideas.
  • Engagement with external bodies had was impressive and the trust was more visible in the local and national arena.
  • Engagement and joint planning between departments was well developed. For example, the information management and technology department, and finance team brought projects to fruition and ensured they worked directly for patient care.
  • We heard many positives about various information technology systems and apps that enabled staff to deliver care more safely and efficiently. The trust’s investment in IT innovation contributed to cost improvement projects to save staff time, improved safety and outcomes for patients and quality of service. Patient’s survey results showed IT had contributed to better care and patients were involved in feedback about the systems. A system called SPIKE gave staff access to monitor performance and leaders saw this as a way to assist data collection and analysis and reduced time on administration tasks. The trust was developing a second version of SPIKE to further improve data management and staff saw this as positive.
  • We were provided with a good description of the way in which the trust implemented Duty of Candour, highlighting that it is in the terms of reference for the investigation of each serious incident that the duty of candour is complied with; patients are contacted before, as part of, and at the conclusion of each investigation.
  • Quality improvement initiatives had begun to make a difference. The system for agreeing projects to be supported showed commitment to the principles the trust upheld. Staff involved service users in project decision that needed to be made. Senior managers encouraged staff to consider and suggest quality improvement projects to improve services for patients. Staff had opportunity to contribute to discussions about the strategy of their service. Staff felt listened to and supported.
  • Patient care and service user experience was clearly central and embedded into the purpose of all staff and driven through the values, culture and leadership.
  • In 2017, Astley Court reduced their bed numbers from twelve to six beds. This was in response to the national transforming care agenda review. The trust used additional funding to introduce a community team, which was based and run from the ward. The focus of this team was to provide intensive support to patients in the community, prevent admissions to hospital wherever possible, and facilitate early discharge home.
  • The national quality network was fulsome in its praise, and recognised Broadband Clinic and the Eric Shepherd unit for outstanding practice in areas such as recruitment, team working, recovery focus, and patient satisfaction.

However:

  • Attention to safety issues needed improvement in particular the recording of seclusion and monitoring seclusion practices.
  • The trust’s system for rating and recording serious incidents gave us cause for concern. The categorisation of incidents against the NHS framework was not accurate and left us concerned that serious incidents lacked full investigation, reporting and learning. This was significant the trust did not always recognise the seriousness of some events and therefore was not able to learn lessons from those events.
  • The trust’s pace of responding to lessons learnt was a concern. There were similar issues that had repeated in several services across the trust, such as seclusion practice and patients whose behaviour challenged the environment. The trust’s level of scrutiny and oversight to anticipate future risk and planning services was a concern.
  • At the time of inspection, the trust did not collect centrally, data on compliance with supervision. Managers used their own spreadsheets to capture supervision data. On acute wards for adult of working age and PICU wards, supervision compliance was 42%.
  • The team on Albany Lodge was new, and lacked leadership and co-ordination. The ward appeared disorganised and lacked relational security when we visited. We were told support had been arranged for the manager, including mentoring.

On the child and adolescent mental health ward, managers recognised that data about staff attendance at mandatory training was incorrect. However, they took no action to ensure that this information was corrected.

Checks on specific services

Child and adolescent mental health wards

Good

Updated 25 April 2018

The summary for this service appears in the overall summary of this report.

 

Wards for people with a learning disability or autism

Outstanding

Updated 25 April 2018

The summary for this service appears in the overall summary of this report.

Forensic inpatient/secure wards

Outstanding

Updated 25 April 2018

The summary for this service appears in the overall summary of this report.

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

Requires improvement

Updated 25 April 2018

The summary for this service appears in the overall summary of this report.

Community-based mental health services for older people

Good

Updated 8 September 2015

We rated community-based mental health services for older people as good because:

  • The service operated safely, with sufficient numbers of well-trained staff who were aware of, and used, safe practice such as the lone worker policy and procedures.
  • The needs of people using the service were assessed and responded to promptly and monitored effectively.
  • The teams had a good mix of professionals, nurses, support workers, psychologists, pharmacists, social workers, psychiatrists, occupational therapists, speech and language therapists, who worked together well.
  • People using the service were treated with respect and dignity and their individual needs responded to. They were very complimentary about the service and the staff they came into contact with.

  • There was a low turnover of staff throughout the services. This offered people using the service consistency and experience.

  • Staff were highly motivated, caring and enthusiastic about their work. This was reflected in their contact with people who used the service.
  • Changes to the service had been managed effectively, whereby three out of the four areas had relocated services to central ‘hubs’. Staff working in these hubs had responded positively. One area, the North West, was still to move to a hub.

We also noted:

  • The environments of some memory clinics were not very welcoming for people using them, and there were delays for some people between being referred and receiving an assessment.
  • It was not always clear if people using the service had had mental capacity assessments, which is needed to ensure people are not given treatment they are unable to consent to.

Mental health crisis services and health-based places of safety

Good

Updated 8 September 2015

We gave an overall rating for mental health crisis and health based place of safety of Good because:

  • Staff within the crisis teams we inspected demonstrated a good knowledge and understanding of people using the service. In the shadow visits we undertook, it was clear that staff had an understanding of people’s needs. We observed examples of very sensitive information being discussed with the visiting professionals and being handled in an empathic and supportive way with choices being offered on how to guide and direct people to support their own independence.

  • The crisis teams were responsible for gatekeeping 100% of all inpatient beds. They did this effectively. The teams maintained close working links with the outpatient and inpatient services across their geographical areas which enabled this effective level of gatekeeping.

  • Staff morale was high in all of the teams we visited. Staff told us they were proud of the job they did and felt well supported in their roles.

However:

  • At the North West CATT four of the eight medication cards we checked contained errors in administration recording. There were gaps in administration of medications and medicines had been given when dates showed they had not been prescribed. This meant that people’s medication was not always being administered in a safe way. This was reported at the time through the trust incident reporting system.

  • At the North West CATT the medication cupboard temperature was not being recorded. This meant that medication was not being stored in a safe way. This was discussed with the manager at the time of the inspection and a system had been put in place by the time we left the service.

  • All the crisis teams we inspected were aware of the risks associated with lone working but there was no consistency of approach across the crisis teams in how they were managing the risks. The trust had a lone worker policy however staff did not always appear to be following this.

  • The section 136 suites at Lister Hospital and Kingsley Green children’s 136 suite did not provide a safe and/or suitable environment for the assessment of patients detained under section 136 of the Mental Health Act 1983.

  • In the crisis teams out of the 15 sets of support plans we looked at, only four sets had recorded that the person receiving the service had been given a copy of their care plans and there was no documented reason as to why this had not been done. We spoke to 8 people receiving care from the crisis teams and four of those people were not aware of or had not received a copy of their care plan.

Community-based mental health services for adults of working age

Good

Updated 8 September 2015

We rated Hertfordshire University Partnership NHS Foundation Trust community-based mental health services for adults of working age as Good because:

  • Staff had completed safeguarding training and could explain safeguarding procedures and examples of recent safeguarding concerns. There were good examples of multi-disciplinary working across the teams including collaborative working between professions.

  • There was a good range of psychological therapies available including dialectical behaviour therapy, cognitive behaviour therapy, drama and art therapy. Most staff were up to date with their supervision and appraisals and could access specialist training.

  • Staff demonstrated a good understanding of people’s individual needs. Most people who use services and their carers we spoke with gave positive feedback about the care and support they received.

However:

  • There was a high number of vacancies and use of agency staff across the teams we visited that impacted on people’s continuity of care.

  • We found a high number of cases that had not been allocated a care coordinator within 28 days. People who use the services experienced a delay in allocation and high frequency of change in care coordinators.

  • All staff did not have lone working devices, or were not aware of what the lone working procedures were.

  • Following a serious incident at Hertford County Hospital, all staff were not aware of the learnings or outcomes. Staff at Hertford County Hospital and Waverley Road also were not all provided with a debrief after serious incidents.

  • In the care records we reviewed, risk assessments did not always identify people’s risk including histories of self harm. People’s care plans were not always up to date. They also lacked evidence of how the person who uses the service and/or their carer were involved with the person’s care and treatment. We also found that people did not always have a completed physical health assessment.

  • Staff we spoke with found the trust’s electronic database system difficult to use and they could not access people’s information easily.

  • Staff were unhappy with the recent transformation and this affected their morale. However, they felt supported by their team and manager. Despite issues with staffing, we observed staff providing high quality care to people who use services.

Wards for older people with mental health problems

Good

Updated 8 September 2015

We rated Hertfordshire Partnership University NHS Foundation Trust wards for older people with mental health problems as Good because:

  • Care and treatment was delivered in a person centred, kind, respectful and considerate way
  • Care Programme Approach and ward reviews were carried out in a timely manner
  • Patients and their carers were involved as partners in their care
  • Patients told us they felt safe and were satisfied with the care they received
  • There were care plans and risk assessments in place for patients
  • There was a culture of staff managing patient behaviours effectively and only using medication when they needed to
  • Patients had routine and regular contact with a range of health professionals to promote their physical health and well-being
  • Different professions worked effectively together to assess the needs of patients and to support the discharge process
  • There was an active occupational therapy team and they developed individual plans and therapeutic activities with patients.
  • Patients and their carers told us that staff treated them with kindness, dignity and respect.
  • There was an active chaplaincy service which supported patients with their spiritual needs
  • Staff showed a clear understanding of the Mental Health Act and the Mental Capacity Act including Deprivation of Liberty Safeguards.
  • Staff told us they felt valued and supported by the Trust and felt confident they could report their concerns without fear of reprisal.
  • There was an active training plan in place for staff to enable them to keep up to date with their clinical or leadership skills and to develop these further
  • There were robust systems in place to record incidents and learning from incidents was routinely shared
  • Morale amongst staff we spoke to was generally good and staff were clear about their roles and responsibilities
  • Local leadership was available and supportive to staff

However:

  • Arrangements for medication management did not keep all patients safe. Some patients did not receive the recommended monitoring they should have received following administration of “as needed” or PRN medications for agitation and one patient received an inhaler that was not prescribed for them. There was no involvement from pharmacy staff in medicines reconciliation and covert medication plans were not always reviewed in line with the Trust’s own policy or signed by a pharmacist.
  • Care plans were not completed in a personalised way which meant they did not reflect the person centred way that we saw staff delivering care. Records did not reflect that patients or carers had been involved in developing their care plans or had been given a copy, though most people told us they had been involved. Risk assessments and care plans were not all up to date.
  • A number of staff told us that the introduction of a new shift pattern meant that they were often unable to take their breaks in a timely manner and some staff told us they were often unable to take a break. Some staff told us that they were anxious about some of the reorganisation of the service and were uncertain about the future of some units.

Community mental health services with learning disabilities or autism

Good

Updated 8 September 2015

We rated the Community Learning Disability Services as good because:

  • Staff undertook a risk assessment for every person who used the service and this was reviewed regularly. There were excellent lone working policies and all staff followed these to ensure their safety and that of people who used the service.

  • Comprehensive personalised and holistic assessments were completed in a timely manner. The team included or had access to the full range of health professionals required to care for the people who used the service.

  • Staff were polite, kind and treated people who used the service with respect. People and their relatives told us that staff were compassionate and cared about them. People were actively involved in their care planning and participated in their clinical reviews.

  • The teams were able to assess urgent referrals quickly and non-urgent referrals within an acceptable time. Where possible, people had flexibility in the times of appointments. There was easy access to interpreters and signers. People who used the service knew how to complain.

  • The team’s objectives reflected the trusts values and objectives. There were good and effective governance systems ensuring good quality and safety. There were opportunities for leadership development. Staff were offered the opportunity to give feedback on services and input into the service development.

Long stay or rehabilitation mental health wards for working age adults

Good

Updated 8 September 2015

We gave an overall rating for long stay/rehabilitation wards of good because:

We found that the wards were kept clean and well maintained and patients told us that they felt safe. There were enough, suitably qualified and trained staff to provide care to a good standard. At Sovereign House, one qualified and one unqualified staff worked each shift; at The Beacon, two qualified and two unqualified staff worked each shift and at Gainsford House and Hampden House, two qualified and one unqualified staff worked each shift. We found that patients’ risk assessments and formulations were robust and person centred. We found the service had strong mechanisms in place to report incidents and we saw evidence that the service learnt from when things had gone wrong. We found, however, that patients were not protected against the risks associated with the unsafe use and management of medicines. This related to the rehabilitation wards not having appropriate arrangements in place for obtaining, recording, and dispensing medicines.

The assessment of patients’ needs and the planning of their care was individualised and had a focus on recovery. We found staff had a good understanding of the Mental Health Act 1983 (MHA), the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS) and the associated Codes of Practice. We saw throughout all of the wards that the multi-disciplinary teams were involved in assessing and delivering patient care. We found motivated and supportive ancillary staff on all of the wards.

We found caring and motivated staff, and, saw good, professional and respectful interactions between staff and patients during our inspection. Patients commented positively about how kind the staff were towards them. We saw evidence of initiatives implemented to involve patients in their care and treatment. These included the recovery STAR tool and daily ward briefings with all patients and staff.

We found bed management processes were effective. Patients were able to access a rehabilitation bed when required and were actively engaged, through a recovery focussed model of care, to prepare for community living. We found a developing service model and care pathway which optimised patients’ recovery, comfort and dignity. We found a varied, strong and recovery orientated programme of therapeutic activities, many of which were making use of the local mainstream, community facilities. These included many community based sporting activities, as well as person centred interpersonal skills training. We noted the service was responsive to listening to concerns or ideas made by patients and their relatives to improve services.

We found all staff to have good morale and that they felt well supported and engaged with a visible and strong leadership team which included both clinicians and managers. We found governance structures were clear, well documented, adhered to by all of the wards and reported accurately. We noted a quality initiative called, “show casing” which identified a particular area of the service where a development or improvement had been identified. This was then advertised and celebrated across the rehabilitation service and the rest of the trust. We saw that this particularly motivated staff and gave them impetus to continue to improve the quality of care and treatment provided.

Specialist community mental health services for children and young people

Good

Updated 8 September 2015

We rated the community child & adolescent mental health services as good overall because:

  • Due to the shortages in staff, the services relied heavily on bank and agency staff. As such, recruitment of substantive staff was active at the time of the inspection. This was having a knock on effect on key areas of the service such as appointment waiting times, completion of risk assessments and staff morale. Psychiatrists were also found to be carrying higher than normal caseloads. This was in part due to a large number of patients with ADHD who required ongoing medication reviews.
  • Staff reported IT problems within the services; most notably at the adolescent drug & alcohol service where they had limited access to the electronic patient record system (BOMIC) for over 6 months.  This issue was being escalated through the county council at the time of the inspection as the solution rests wit the IT provider.

  • The team did however find that reporting and learning from incidents was being achieved. We saw evidence of the dissemination of lessons learned throughout the services inspected.

  • The services were effective overall. The inspection team viewed evidence of robust risk assessments, ongoing assessments and outcomes being achieved. Regular audits were carried out in order to monitor effectiveness in key areas such as waiting times, infection control and safeguarding and the outcomes of these discussed within the directorate governance meetings. In order to provide safe and cohesive pathways, inter-agency working with local authorities and internal Trust partners was also in evidence.

  • Caring throughout the services was of a good standard. We saw evidence of staff showing compassion and empathy towards the young people in their care. Young people and their families were involved in decisions regarding their care.

  • Responsiveness within the services was evident and of a good standard. Referrals were received via the single point of access and also internally through the various child and adolescent mental health teams. We saw good examples of the services meeting assessment targets; 88% of young people were being assessed within 28 days of referral and assessments within four hours for those presenting in the emergency department of the local general hospitals.
  • The inspection team rated the well-led element of the child and adolescent mental health services as good. This was due to the notable alignment of the services with the trust’s vision and values. The managers that we spoke with provided evidence that they and staff are offered development. We also noted governance systems that robustly monitored performance, risk and quality. Senior management and team leaders provided visible leadership.