Devon Partnership NHS Trust

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Leadership across the service was consistent, managers knew their service well and understood the strengths and challenges. Staff reported being able to approach leaders with concerns, and knew of the processes in place to escalate concerns if they needed to.

Ward managers reported they were confident senior leaders understood their challenges and were supportive.

The Trust has worked with other NHS mental health Trusts to establish a new ligature risk management system. However, this was not fully embedded across the Trust and a breach of regulation 17 (Good governance) was identified.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff understood the Trust had various strategies that targeted different areas of the care and treatment provided. This included the carers strategy, physical healthcare strategy, clinical strategy and the overall Trust strategy.

Leaders at service level had clear expectations and aspirations of the service provided within acute and Psychiatric Intensive Care Units (PICUs) in the Trust.

Leaders understood the challenges and accepted that positive cultures were not fully embedded across all areas of the services.

Staff we spoke to did not raise any concerns regarding poor culture. Service leads we spoke to provided information showing how poor culture had been addressed on the wards. The ‘promoting a positive working environment policy’ was utilised to manage this issue.

A mental health, learning disabilities and autism inpatient services quality improvement project was underway across parts of the service. The Trust utilised the ‘Promoting a positive working environment policy’ to manage issues where poor culture and poor practice negatively affected patient experience, staff morale and cohesive working relationships.

Staff told us that leaders and senior members of the Trust were approachable and had a background in clinical roles which demonstrated understanding of ‘front line working’ challenges.

Leaders at a local level demonstrated an open-door policy for staff. Staff we spoke to reported they felt comfortable speaking openly with their managers and discussing their needs and concerns without fear of reprisal.

The Trust had a ‘Promoting a positive working environment policy’.

Yearly action plans were outlined within the NHS Workforce Race Equality Standards (WRES) report for the Trust to address identified areas of concern. Agenda items include, declaration of protected characteristics, recruitment and retention, discrimination, staff voice and training, learning and development.

Staff who required reasonable adjustments to fulfil their role were provided with support and assistance by leadership in accordance with the ‘staff reasonable adjustment policy’.

Staff told us they understood the freedom to speak up process and its designed function. However, some staff told us they had negative experiences of using the freedom to speak up process and stated they were reluctant to use it due to lack of confidence with its effectiveness.

The Trust had a freedom to speak up policy.

There was a freedom to speak up guardian and posters were displayed on the wards to show staff how to use the process.

The Trust also provided e-learning to support and encourage staff to speak up, with additional modules for senior leaders and managers to complete.

Staff were positive about working for the Trust and completed equality and diversity training as part of their mandatory training requirement.

Staff told us about progression and learning opportunities within the organisation. No staff raised concerns about accessing support or opportunity due to a protected characteristic.

The Trust worked with globally educated nurses to assist with integration in local communities, this involved support with education around cultural differences, financial and housing arrangements and other local supporting mechanisms. This was part of the community engagement program the Trust facilitated.

The Trust had an Equality, Diversity and Inclusion policy aimed at promoting, valuing and achieving these aspects within the Trust. This policy included an impact assessment which evidenced consideration whether a particular group were affected more or less than another.

Leaders told us about regular reviews and audits that that took place to maintain quality of care and treatment to patients. Staff knew about processes that took place and why they were important. However, not all staff were able to explain or find key documentation relevant to ensure patient safety.

The Trust could not ensure that systems and processes designed to assess, monitor, and mitigate ligature risks to patients were operating effectively. The Trust had not taken adequate action following findings identified in the previous inspection in 2021, where a requirement notice was issued following the identified breach of regulation 12 (safe care and treatment), linked to ligature risk assessments being too generic.

During this inspection we found that improvements had not been made to ligature risk assessments, and mitigations documented on ligature risk assessments to lower and prevent risk of ligature incidents occurring. These remained generic and were not specific to the identified risk or to the individual ward areas. This meant the ligature risk assessments did not adequately equip frontline staff with the information necessary to manage and reduce the risk of ligature incidents.

It is widely recognised, and supported by national learning, that robust ligature risk assessments are a fundamental component of patient safety in mental health settings. The continuation of this issue despite prior regulatory action demonstrates a lack of evidence of appropriate oversight by leadership within the Trust. This represents a breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Salus ward did not have a settled leadership team. The Trust were working to address this and explained how effective appointments to key roles, such as the ward manager, were being undertaken.

Other areas of governance within the service were appropriate. Leaders undertook various clinical audits, these were analysed and discussed within clinical governance meetings and outcomes with action plans were implemented to address areas of concern.

Workforce performance audits were recorded and analysed by the adult workforce team. This helped inform the Trust and identify themes in areas including but not limited to supervision compliance and absence. The Trust also collected and analysed data on staff turnover and exit interviews.

Patient’s raised no concerns regarding this quality statement.

Patient’s raised no concerns regarding this quality statement.

Partnerships with external organisations were in place that benefit patients when integrating back into the community, these groups included promoting mental and physical wellbeing. Other groups promoted life-skills workshops and access to local resources.

Senior ward staff told us about being part of the national Mental Health Act quality improvement programme, a learning disabilities project and the patient and carer race equality network (PCREF). They were knowledgeable about what was involved and what the aims of these learning and improvement opportunities were.

Staff told us how they used outcomes from quality improvement initiatives to help inform quality of patient care and experiences.

We reviewed information outlining learning and improvement that was cascaded to staff within meeting minutes.

However, staff were not aware of information and action plans following the previous inspection which highlighted required areas of improvement in ligature risk management. This meant not all action plans to drive improvement were effective.

Learning from incidents across wards was discussed at Learning from Experience (LfE) meetings, these are held monthly and attended by band 7 and 8 staff. Information was cascaded to teams at ward level and identified learning was implemented. The Trust had a ‘Bright Ideas’ form for staff to share their idea for improvement or innovations. A quality improvement project was in progress at the time of our visit called ‘Safe from Suicide’. This aimed to help manage patient strategies for the prevention of suicide. Additional improvement strategies implemented by the Trust also included simulation training on Salus ward, reducing restrictive practice simulation training and improving the nutritional screening process on mental health wards.