You are here

Provider: Berkshire Healthcare NHS Foundation Trust Outstanding

Reports


Inspection carried out on 05 Nov to 12 Dec 2019

During a routine inspection

Our rating of the trust improved. We rated it as outstanding because:

  • We rated the trust outstanding overall because over the past four inspections we have seen a consistent pattern of progressive improvement in the quality of core services that is reflected in the ratings of these services.
  • Since the last inspection in 2018 the trust has continued to make considerable improvements, building on many of the high quality services it delivered.
  • In rating the trust, we have taken into account the previous ratings of the eight mental health and community health core services not inspected this time as well as the six we did inspect.
  • We rated safe, effective and caring as good and responsive and well led as outstanding. Following this inspection four of the trust’s fourteen services were rated outstanding and eleven were rated good.
  • The trust had made the majority of the improvements we said that it should make following our last inspection.
  • We found that the trust had a highly skilled, strong, stable and experienced senior team, including the chair and non-executive directors. Leaders had the skills, knowledge, integrity and experience to perform their roles and had a good understanding of the services they were responsible for delivering. There was compassionate, inclusive and effective leadership at all levels. Leaders were visible in the service and approachable to patients and staff.

  • The trust had created a positive culture where people, patients, carers and staff could share their experiences and concerns and where there was a really genuine commitment to learning and making improvements. Staff across the trust felt valued and there was a real focus on doing what was best for people, both staff, patients and carers and a real commitment to the delivery of good quality patient care at every level. Staff at all levels of the trust were proud to work there and morale amongst staff was good. Both the Council of Governors and the trade union representatives were very positive about how the trust leaders worked with them in an open and transparent way.

  • There was a clear vision, underpinned by a set of values that were well understood by staff across the trust. Staff were consulted and felt included in strategic changes and developments. We noted some really clear thoughts and developments around aligning with partners across the health and care economy to further develop services that put patients at the centre of care. The trust was taking a leading role in a number of the system wide developments and was a key partner in two exemplar integrated care systems, the board was visibly engaged in and supportive to the work of the wider health and social care system.
  • The involvement of patients was central to the work of the trust. Patients were supported to express their wishes and to be active participants in meetings where their care was discussed. The involvement of patients and carers in the wider work of the trust had developed further since the last inspection with some excellent examples of coproduction work. For example, children and young people, parents and carers were actively involved in the design and delivery of the service and patients had been involved in quality improvement in acute wards for adults of working age and psychiatric intensive care units. This had resulted in a reduction in staff assaults and patient restraint.
  • Staff put patients at the centre of everything they did. Staff treated all patients with compassion, respect and kindness. The privacy and dignity of patients was maintained. Staff worked in partnership with patients to ensure they were supported to understand and manage their care and treatment.
  • The end of life care services and community adults services provided innovative approaches to integrated person-centred pathways of care that involved other service providers, particularly for patients with multiple and complex needs. The services were flexible, provided informed choice and ensured continuity of care.
  • Staff assessed and managed risks to patients well and followed best practice in anticipating and de-escalating volatile situations. There had been a reduction in incidents of violence and aggression across the inpatient wards. In acute wards for adults of working age and psychiatric intensive care units a positive risk panel was held weekly, staff could discuss particularly complex, high risk patients with senior clinicians in order to agree an effective care plan and to review risk. Staff understood how to protect patients from abuse and the service worked well with other agencies to do so.
  • The trust had very strong staff networks in place for people with protected characteristics and network leads had some protected time to develop these further. These were the BAME network, LGBT & Friends network for LGBT staff and allies and the newest of these networks was the Purple Network for people with disabilities, long term health conditions or caring responsibilities, with a membership of 300 people. The trust recognised that the work to further develop their commitment to equality, diversity and human rights was ongoing and there was passionate support for this at board level, for example, reverse mentoring with staff from all three staff networks. Each network had an executive champion and worked in partnership with other staff networks, allies and over 100 champions across the organisation. The Diversity Steering group was chaired by the executive director of corporate affairs.
  • The trust had made further progress in their quality improvement methodology. We saw that this methodology was embedded throughout the trust and was championed at all levels from ward to board, gave genuine opportunities for staff and patients in wards and teams to identify areas for improvement and make changes. The trust consistently encouraged and supported staff to innovate and develop new ideas. For example, in CAMHS an online peer-support based system, Support Hope and Recovery Online Network (SHaRON), had been developed. This provided a confidential space for children and young people and their families to access support and the hydration project on Henry Tudor ward which had introduced several initiatives that encouraged and promoted hydration, such as a drink station pit stop which provided a visual reminder for patient to drink. This successful initiative was being rolled out across the trust.
  • The trust had strong governance systems supported by high quality performance information. This meant that at all levels of the organisation staff and members of the board had access to useful information that enabled them to gain assurance and make improvements where needed. This enabled the trust to achieve a balance between assurance and improvement work.
  • The trust had continued to build on its innovation as a Global Digital Exemplar, sharing learning and supporting other trusts to make improvements in technology. Innovation was at the core of the trust strategy, with the use of approaches such as True North goals and Listening into Action to engage with staff and empower them to make changes quickly and with board support
  • The chief executive had taken a lead in the national benchmarking for mental health and community health.

However;

  • In specialist community mental health services for children and young people we found that the average waiting time for assessment in the county wide attention deficit hyperactivity disorder (ADHD) and autism pathway for children and young people was 33 weeks. In East Berkshire the average waiting time from referral to treatment in the specialist community teams was 23 weeks. This was lower in West Berkshire, where it was 15 weeks. The trust had developed waiting list initiatives to address this, and support provided for waiters and appropriate actions taken for urgent cases. There had been increasing rates of referrals into CAMHS services, and the trust had secured additional funding for early intervention for young people. Waiting lists were a key quality concern and were monitored by the trust board and commissioning groups. There were several initiatives that the teams and trust were involved in to reduce waitlists and ensure risks for children and young people waiting were managed and responded to. The trust had identified a gap in the commissioning of this service and the CAMHs leadership team were engaged in a commissioner-led project to review pathways and services for autism and ADHD and to identify a new service framework based on a comprehensive review of the capacity and demand for these services.
  • Patients on the acute wards for adults of working age and psychiatric intensive care units were subject to several blanket restrictions. rules and policies that restricted a patient’s liberty and rights, which were routinely applied, without individual risk assessments to justify their application.
  • Some of the ward environments of the child and adolescent mental health ward and acute wards for adults of working age were in need of redecoration. However, the trust does have a rolling programme of redecoration in order to address this.


CQC inspections of services

Service reports published 26 March 2020
Inspection carried out on 05 Nov to 12 Dec 2019 During an inspection of Specialist community mental health services for children and young people Download report PDF (opens in a new tab)Download report PDF (opens in a new tab)
Inspection carried out on N/A During an inspection of Reference: End of life care not found Download report PDF (opens in a new tab)
Inspection carried out on 05 Nov to 12 Dec 2019 During an inspection of Community health inpatient services Download report PDF (opens in a new tab)Download report PDF (opens in a new tab)
Inspection carried out on N/A During an inspection of Reference: End of life care not found Download report PDF (opens in a new tab)
Inspection carried out on 05 Nov to 12 Dec 2019 During an inspection of Community health services for adults Download report PDF (opens in a new tab)Download report PDF (opens in a new tab)
Inspection carried out on N/A During an inspection of Reference: End of life care not found Download report PDF (opens in a new tab)
Inspection carried out on 05 Nov to 12 Dec 2019 During an inspection of Acute wards for adults of working age and psychiatric intensive care units Download report PDF (opens in a new tab)Download report PDF (opens in a new tab)
Inspection carried out on 05 Nov to 12 Dec 2019 During an inspection of Community end of life care Download report PDF (opens in a new tab)Download report PDF (opens in a new tab)
Inspection carried out on N/A During an inspection of Reference: End of life care not found Download report PDF (opens in a new tab)
Inspection carried out on N/A During an inspection of Reference: End of life care not found Download report PDF (opens in a new tab)
Inspection carried out on N/A During an inspection of Reference: End of life care not found Download report PDF (opens in a new tab)
Inspection carried out on N/A During an inspection of Reference: End of life care not found Download report PDF (opens in a new tab)
Inspection carried out on 05 Nov to 12 Dec 2019 During an inspection of Child and adolescent mental health wards Download report PDF (opens in a new tab)Download report PDF (opens in a new tab)
See more service reports published 26 March 2020
Service reports published 2 October 2018
Inspection carried out on 05 June 2018 to 12 July 2018 During an inspection of Wards for people with a learning disability or autism Download report PDF (opens in a new tab)Download report PDF (opens in a new tab)
Inspection carried out on 05 June 2018 to 12 July 2018 During an inspection of Wards for older people with mental health problems Download report PDF (opens in a new tab)Download report PDF (opens in a new tab)
Inspection carried out on 05 June 2018 to 12 July 2018 During an inspection of Acute wards for adults of working age and psychiatric intensive care units Download report PDF (opens in a new tab)Download report PDF (opens in a new tab)
Inspection carried out on 05 June 2018 to 12 July 2018 During an inspection of Mental health crisis services and health-based places of safety Download report PDF (opens in a new tab)Download report PDF (opens in a new tab)
Inspection carried out on 05 June 2018 to 12 July 2018 During an inspection of Community health services for children, young people and families Download report PDF (opens in a new tab)Download report PDF (opens in a new tab)
Inspection carried out on 05 June 2018 to 12 July 2018 During an inspection of Community health services for adults Download report PDF (opens in a new tab)Download report PDF (opens in a new tab)
Inspection carried out on 05 June 2018 to 12 July 2018 During an inspection of Community urgent care services Download report PDF (opens in a new tab)Download report PDF (opens in a new tab)
See more service reports published 2 October 2018
Service reports published 11 December 2017
Inspection carried out on 17 October 2017 During an inspection of Acute wards for adults of working age and psychiatric intensive care units Download report PDF (opens in a new tab)
Service reports published 31 August 2017
Inspection carried out on 15 June 2017 During an inspection of Child and adolescent mental health wards Download report PDF (opens in a new tab)
Inspection carried out on 22 - 23 May 2017 During an inspection of Acute wards for adults of working age and psychiatric intensive care units Download report PDF (opens in a new tab)
Service reports published 27 March 2017
Inspection carried out on 13-14 December 2016 During an inspection of Wards for older people with mental health problems Download report PDF (opens in a new tab)
Inspection carried out on 13-15 December 2016 During an inspection of Acute wards for adults of working age and psychiatric intensive care units Download report PDF (opens in a new tab)
Inspection carried out on 13-15 December 2016 During an inspection of Wards for people with a learning disability or autism Download report PDF (opens in a new tab)
Inspection carried out on 13 December 2016 During an inspection of Child and adolescent mental health wards Download report PDF (opens in a new tab)
See more service reports published 27 March 2017
Service reports published 30 March 2016
Inspection carried out on 7-11 December 2015 During an inspection of Community mental health services with learning disabilities or autism Download report PDF (opens in a new tab)
Inspection carried out on 7-11 and 16 December 2015 During an inspection of Child and adolescent mental health wards Download report PDF (opens in a new tab)
Inspection carried out on 7-11 December 2015 During an inspection of Community end of life care Download report PDF (opens in a new tab)
Inspection carried out on 07 December – 11 December 2015 During an inspection of Community health inpatient services Download report PDF (opens in a new tab)
Inspection carried out on 7 - 11 December 2015 During an inspection of Community health services for children, young people and families Download report PDF (opens in a new tab)
Inspection carried out on 7-11 December 2015 During an inspection of Specialist community mental health services for children and young people Download report PDF (opens in a new tab)
Inspection carried out on 7-11 December 2015 During an inspection of Wards for older people with mental health problems Download report PDF (opens in a new tab)
Inspection carried out on 7 December 2015 to 11 December 2015 During an inspection of Community health services for adults Download report PDF (opens in a new tab)
Inspection carried out on 7-11 December 2015 During an inspection of Wards for people with a learning disability or autism Download report PDF (opens in a new tab)
Inspection carried out on 7-11 December 2015 & 11 February 2016 During an inspection of Acute wards for adults of working age and psychiatric intensive care units Download report PDF (opens in a new tab)
Inspection carried out on 7 - 10 December 2015 During an inspection of Community-based mental health services for adults of working age Download report PDF (opens in a new tab)
Inspection carried out on 7 - 11 December 2015 During an inspection of Mental health crisis services and health-based places of safety Download report PDF (opens in a new tab)
Inspection carried out on 7 December 2015 to 10 December 2015 During an inspection of Community-based mental health services for older people Download report PDF (opens in a new tab)
See more service reports published 30 March 2016
Inspection carried out on 05 June 2018 to 12 July 2018

During a routine inspection

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

  • Since the last inspection in 2016, the trust has continued to make improvements. We inspected seven services and carried out a well-led review.
  • We engaged with a range of staff from a variety of professional groups through a series of focus groups with staff from community health and mental health services. Staff were proud to work at the trust and spoke positively about their colleagues and managers.
  • Following this inspection twelve core services were rated as good overall and two were rated outstanding. In rating the trust, we took into account the previous ratings of the seven services not inspected this time.
  • The trust board was strong and confident in performing its role. The executive team were stable and succession planning had been embedded over the last five years. The chair and non-executive directors were committed to ensuring that patients received the best care possible and used their wide range of skills and experience to challenge the executive directors to deliver quality services.
  • The trust had made further progress in the use of a quality improvement methodology. We saw that this methodology gave genuine opportunities for staff and patients in wards and teams to identify areas for improvement and make changes. The use of quality improvement was widespread throughout the trust, both staff and patients were very positive about the potential for improvement.
  • Community Nursing had adopted the Quality Management Improvement Programme (QMIS) and had developed team skills to take a `bottom-up’ approach to problem solving. Examples of improvements included: improvements to low morale through a range of well -being initiatives; and the use of “driver metrics” to focus on harm free care which had seen a reduction in rates of pressure ulcers.
  • Learning summits, led by the Deputy Director of Nursing, were held for all pressure ulcers within community health and mental health inpatient units. All staff involved in the patients’ care are invited to attend and supported by Tissue Viability Clinical Nurse Specialists. Themes and learning from all Learning summits are shared across the organisation via Patient Safety Quality meetings.
  • The trust had addressed most of the areas where improvements were needed from the last inspection.
  • In the wards for people with a learning disability staff had received training in positive behaviour support, patients had individualised behaviour support plans and staff were supporting patients, who had challenging behaviours, appropriately.
  • The trust had strong governance systems supported by good quality performance information. This meant that at all levels of the organisation staff and members of the board had access to useful information that enabled them to gain assurance and make improvements where needed. This enabled the trust to achieve a balance between assurance and improvement work.

Inspection carried out on 7 - 11 December 2015 Re inspected 13 – 15 December 2016.

During a routine inspection

We have given Berkshire Health Care NHS Foundation Trust a rating of good and this was because:

We rated all community and inpatient health services as good. Of the nine core services we inspected in mental health we rated seven as good, one as outstanding and one as requires improvement.

The trust has much to be proud of and also some areas that need to improve. The trust was well led with an experienced and proactive senior leadership team and board. There were also many committed and enthusiastic senior staff throughout the organisation working hard to manage and improve services. The trust responded in an open and honest way to the findings of the inspection team. They responded to put things right immediately where we had raised concerns. They were open, transparent and not defensive.

The main areas that were positive were as follows:

  • The wards and clinical team bases were clean and well maintained.
  • There was good evidence that medicines were well managed across the trust.
  • Staff made good use of best practice guidelines and outcome measures.
  • There was a strong culture of multi-disciplinary working. Professionals, teams and agencies worked well together.
  • Staff recognised and understood their responsibilities in relation to safeguarding. Staff were aware of how to raise an incident and there was a good culture of learning post a serious untoward incident.
  • Patients and their carers were positive about the care and treatment they received and felt they were treated with dignity and respect.
  • Staff enjoyed working for Berkshire Health Care NHS Foundation Trust. They told us that the board were visible and approachable. They also spoke positively about the opportunities for professional development and told us that managers encouraged them to attend external training and conferences.
  • The trust had taken on some challenging services, particularly in primary medical services, one of which had been placed in special measures. They had managed to turn this service around and it is now rated as good.
  • Community health services were all rated as good across the board.

There were two core services that required improvement. These were the wards for people with a learning disability and the Circuit Lane medical centre. The main areas for improvement are as follows:

  • There was poor management of ligature points on the learning disability inpatient wards and the child and adolescent inpatient ward. A ligature point can be used by people experiencing suicidal thoughts to harm themselves. On the learning disability inpatient wards the trust had identified numerous potential ligature points, and proposed an action plan to mitigate each. However, staff did not maintain the required level of patient observation; there were an insufficient number of ligature cutters given the physical layout of the ward; and, staff had not received training in the use of ligature cutters.

  • Neither the child and adolescent inpatient ward or learning disability inpatient wards met the requirements set out by the Department of Health guidance ‘Privacy and Dignity, the elimination of mixed sex accommodation’. This states that hospitals should provide accommodation which ensures that men and women are separated and have access to their own facilities, such as toilets and bathrooms. This was also a concern at the high dependency unit at Prospect Park hospital.

  • Staff did not monitor people’s physical health needs adequately for people with a learning disability.

  • Some staff were not communicating well with people with a learning disability, as they lacked the necessary skills and training to do this.

  • The trust had not implemented or monitored changes needed in the appointment system in response to patients’ at the Circuit lane surgery. This surgery also needed to ensure that they improved access by telephone to the GP practice.

  • We were concerned about the quality and safety of care on the older people’s mental health inpatient units. Not all staff were aware of the risks that individual patients faced, nor of the level of observation and support they needed to keep them safe. Not all staff knew how to prevent or care for pressure ulcers. Not all staff on these wards were receiving regular supervision.

We issued the trust with a warning notice in respect of the high dependency unit at Prospect Park Hospital. This was because the trust had failed to ensure that the rights of those people subject to long-term segregation were being met. This breached their policy and the Mental Health Act 1983 accompanying code of practice. We returned to the high dependency unit at Prospect Park on the 11th of February 2016 and were pleased to report that the trust had resolved the concerns raised in the warning notice and were fully compliant with the law.

In December 2016 we undertook a follow up inspection to find out whether Berkshire Healthcare NHS Foundation Trust had made necessary improvements to the four core services we had rated as requires improvement for the Safe key question. At the comprehensive inspection in December 2015 we issued the trust with five requirement notices that affected these four core services.

• Wards for people with learning disabilities

• Wards for older people with mental health problems

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

• Child and adolescent mental health inpatient ward

These related to the following regulations under the Health and Social Care Act (Regulated Activities) Regulations 2014:

• Regulation 9 Person centred care

• Regulation 10 Dignity and respect

• Regulation 12 Safe care and treatment

• Regulation 17 Good governance

• Regulation 18 Staffing

We returned in December 2016 and we found that Berkshire Health Care Foundation Trust had acted to meet the requirement notices we issued after our inspection in 2015.

We therefore rated the Safe key question as Good overall.

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.


Joint inspection reports with Ofsted

We carry out joint inspections with Ofsted. As part of each inspection, we look at the way health services provide care and treatment to people.


Organisation Review of Compliance


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.