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Provider: Sussex Partnership NHS Foundation Trust Good

Read our previous full service inspection reports for Sussex Partnership NHS Foundation Trust, published on 28 May 2015.

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 7 June 2019

Inspection areas

Safe

Good

Updated 7 June 2019

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

• Nine of the 11 trust core services are rated as good for safe. We took into account the previous ratings of the six services not inspected this time.

• The trust was working creatively to increase recruitment and retention of staff. There were a number of incentives to attract nurses and doctors to work for the trust. This had reduced the agency spend by 50%. There were still vacancies across services, and ward managers were able to adjust the staffing levels to account for the acuity on the wards.

• Staff followed best practice when storing, prescribing, administering and recording the use of medicines. The chief pharmacist was the lead for the development of the medicines optimisation strategy and provided annual updates to the board on achievements and challenges. The trust had appointed a medicine safety officer. Staffing levels were at establishment and input to the community teams was being increased to reduce hospital admissions and improve community-based care.

However:

• The trust had recently pleaded guilty for the failure to provide safe care and treatment to a patient. This was in relation to a young man who died whilst a patient in the prison healthcare unit at HMP Lewes in February 2016. A recent inspection of the prison healthcare carried out by the CQC Health and Justice team and HMI Prison found that improvements were still required to ensure patients care and treatment needs were met safely at HMP Lewes.

• The rating for the core service of the mental health crisis services and health-based places of safety moved from good to requires improvement. We identified particular concerns at Mill View hospital crisis team. However, within the mental health crisis services and health-based places of safety the trust had not made sure that comprehensive risk assessments and care plans were completed so that patients received person-centred safe care and treatment.

• There was a risk that the threshold for the investigation into the serious incident at Mill View Hospital was set too high although this had been done in consultation with other agencies.

Effective

Good

Updated 7 June 2019

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

• All 11 of the trust core services were rated as good for effective. We took into account the previous ratings of services not inspected this time.

• The trust provided care and treatment to patients based on national guidance. There were many examples of the implementation of best practice being followed across the services.

• Staff assessed the physical and mental health of all patients on admission or during the initial assessment. Care plans were individualised and reviewed regularly through multidisciplinary discussion. Care plans reflected the assessed needs, were personalised, holistic and recovery-oriented.

• Physical healthcare was led by a centralised team who supported and promoted this within services across the trust. A lead physical health practitioner was assigned to each ward. The trust worked hard to encourage patients to make healthy lifestyle choices.

• The trust ensured care and treatment interventions were suitable for the patient group and consistent with national guidance on best practice. For example, we found good implementation of national institute for health and care excellence across the services. Care planning for patients on Iris ward included the use of a therapy doll (a robotic seal). Studies have shown that use of these toys on wards for older people or those with dementia stimulates social interaction between patients and carers.

• The trust monitored the effectiveness of care and treatment and used the findings to improve them. The trust had strong links to the local university and medical schools and was involved in a number of clinical audits and research trials. Quality improvement was being rolled out across the trust, with staff encouraged to use different methodologies to improve patient experience and the areas in which they worked.

• The trust made sure staff were competent for their roles. Staff received an annual appraisal and regular supervision sessions to ensure they were developing and effective in their work with patients.

• There was strong multi-disciplinary working across the services. Psychologists, doctors, nurses and other healthcare professionals worked jointly in all services to provide good care. Ward teams had effective working relationships with other teams within and external to the trust. Inpatient services engaged with them early in the patient’s admission to plan for discharge. For example, in the mental health-based places of safety and crisis services we saw effective multiagency working with a variety of services including the police, ambulance services, approved mental health professionals, street triage and in-patient wards.

• The trust had secure electronic care records systems which enabled relevant staff to access up-to-date, accurate and comprehensive information on patients’ care and treatment.

• Staff had a clear understanding of their roles and responsibilities under the Mental Health Act and Mental Capacity Act. They received good support from the Mental Health Act officers at the trust.

Caring

Outstanding

Updated 7 June 2019

Our rating of caring stayed the same. We took into account the previous ratings of services not inspected this time. We rated it as outstanding because during the inspection period:

• Three of the trust core services were rated as outstanding for caring. The eight other core services were rated as good for caring.

• Feedback from people who use the service, those who are close to them and stakeholders is continually positive about the way staff treat people. We received feedback from a wide range of stakeholders who said that staff at all levels of the trust demonstrated a caring and compassionate approach with patients. Throughout the core service inspections we received positive feedback from patients and their carers of how well they are treated.

• There was a strong, visible person-centred culture. Patients were truly respected and valued as individuals and were empowered as partners in their care. Staff were highly motivated to work with patients and carers to ensure that the care was what they needed and they had a good patient experience. When we joined home visits with the crisis team we observed that staff worked collaboratively with patients; sensitively discussing care and treatment and ensuring patient understanding. In the places of safety patients said that staff had spent time talking with them and explained what would happen next. Within the wards for older people with mental health problems we observed staff treating patients with compassion and care by taking time to listen to them and answering their questions. Patients we spoke with told us staff were always respectful towards them. Patients said the staff tried to meet their needs, that they worked hard and had patients’ best interests and welfare as their priority.

• Staff recognised and respected the totality of patients’ needs. They always took patients’ personal, cultural, social and religious needs into account. All staff we spoke with had an in-depth knowledge of their patients’ likes and dislikes. Patients’ individual preferences and needs were always reflected in how care was delivered. Patients spoke positively about the care they had received. They said that staff were easy to talk to and they had found their support invaluable.

• Work with carers was enhanced through the triangle of care approach that we saw in use in the wards and service we inspected. Relationships between patients, carers and staff were strong and supportive. These relationships were highly valued by staff and promoted by leaders. Feedback from patients, those who are close to them and stakeholders was positive about the way staff at all levels treated patients. One of the wards for older people with mental health problems had signed up for the nationally recognised ‘John’s Campaign’ which was an application of evidence of how they supported carers of people with dementia.

• The trust promoted patient and carer involvement at various opportunities. The trust had recruited over 100 experts by experience since April 2018 and over a third of trust committees included people with lived experience. Befriending volunteers worked in two-thirds of inpatient units. The peer supporter role had developed along with peer apprenticeships. Team Springwell was the trusts’ learning disability experts by experience group who worked on the Springwell project. This was an area of the trust website for people with learning disabilities to access advice, information and support, and to enable people with learning disabilities to have a voice in their care. The trust working together groups had matured over the past year and were chaired or co-chaired by an expert by experience. Representatives fed into service wide leadership meetings and changes were enacted on the wards as a result of feedback. This enabled people to have a real say about how their local services were run and delivered.

• Staff provided emotional support to patients and those close to them to minimise their distress. The core service had different ways of supporting patients and their significant others to help alleviate their anxieties, such as when they or their relative were admitted to hospital.

Responsive

Good

Updated 7 June 2019

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

• Ten core services were rated as good for responsive. We took into account the previous ratings of services not inspected this time. The forensic inpatient or secure wards moved from being rated good to outstanding for responsive.

• The trust had systems in place to support good discharge planning. Staff planned and managed discharges well. In many of the services discharge planning started at the point of admission and they liaised well with services that would provide aftercare, transition to another service or discharge into the community. Within the forensic inpatient or secure wards an ‘assertive transitions team’ aided patient discharge and support beyond the ward. In the mental health crisis services there was an early discharge nurse who bridged the gap between the wards and the crisis team and ensured early discharge was appropriately planned.

• During out of hours people were able to access the mental health line for support. A street triage service was available, which had improved patient treatment journeys. All places of safety were open 24 hours a day, seven days a week. An urgent care lounge had recently been opened at Langley Green Hospital to provide a calm environment for patients waiting to be assessed. The trust planned to open a psychiatric decision unit at Mill View Hospital in April 2019 which would cover the whole of the county. This will be a five-bedded ward to offer an alternative to people attending accident and emergency in a mental health crisis.

• Within the forensic inpatient or secure wards, we found excellent patient engagement with the wider community. This included vocational courses, recovery college, volunteering and work opportunities.

• The wards met the needs of all people who use the service including those with a protected characteristic. Staff supported patients with communication, advocacy and cultural and spiritual support. Langley Green Hospital wards for older people with mental health problems was awarded a gold inclusion award for their lesbian, gay, bisexual, transsexual, questioning (LGBTQ) work. Staff had access to interpreters and information leaflets in a range of languages was available on the intranet.

• The trust ensured that wards had a good range of rooms to aid patient recovery including activity rooms, therapy rooms, clinical rooms. The forensic inpatient or secure wards at the Hellingly Centre had a pottery room that was frequently used for activities. Dormitories were still present on three of the wards for older people with mental health problems. Whilst the patients we spoke with were happy with the arrangement, this was on the trust risk register to monitor risk management and as part of their plans to eliminate mixed sex accommodation.

• The trust complaints procedure was on display throughout the services. Patients confirmed they were given information about how to complain or provide feedback when they were admitted.

However:

• The trust did not yet have a 24-hour crisis service but had recently received funding for this to be implemented in April 2020.

• Due to high demand for admissions on Heathfield ward for older people with mental health problems, beds were not always available to patients when returning from leave.

• The four dormitories on Heathfield older people ward had only one sink each. This meant if a patient was using the dormitory sink another patient wishing to also use the sink might have to go out to use the ward bathroom or use a bowl in their bed space.

• Approved mental health professionals and police informed us there were sometimes delays in identifying an available place of safety because the referral process involved a pager, which then delayed a response to their initial contact.

Well-led

Good

Updated 7 June 2019

Our rating of well-led stayed the same. We rated it as good because:

• All 11 of the trust core services were rated as good. We took into account the previous ratings of services not inspected this time.

• The two adult social care services provided by the trust are rated as good.

• Leaders at all levels within the trust had the skills, knowledge and experience to perform their roles. They had a good understanding of their lines of responsibility and how changes in these impacted on other areas of the trust services. Local leaders understood their services well, were visible in the service and approachable to patients and staff.

• There had been a sustained improvement in the culture of the trust. There was high morale amongst staff who were proud to work for the trust and felt valued and supported. Ward managers encouraged staff to recognise and celebrate their success. Staff felt able to raise concerns without fear of retribution. They felt inspired and able to be innovative and make changes in the services in which they worked.

• Quality improvement had been embraced by the trust and developed well since the previous well led review. There was a continued drive on quality improvement training and staff getting involved in projects. There was a quality house that accommodated the central team who were dedicated to supporting staff to realise their ideas, based on recognised quality improvement methodologies. Staff spoke of the developments in the quality improvement work and methodologies gave them the structure and tools to experiment with new ideas. Staff did not feel they would be rebuked if something didn’t work out, and understood it was a process of improvement where they were allowed to not always get it right. Further work was needed to ensure that the learning and improvements of projects and best practice initiatives were shared across services, particularly core services. For example, in the wards for older people with mental health problems we found wards carrying out excellent work to improve the patient experience. However, there was a lack of sharing, as other older people wards were not aware of the good work taking place in other older people wards across the trust.

• The chief executive was well respected by all staff and stakeholders. Her visibility across services was highly valued and appreciated by staff, particularly when she visited every ward on Christmas day. Staff found her to be very approachable, responsive, decisive and understanding of the daily challenges they faced in their work.

• Staff knew and understood the trust vision and values and how they were applied in the work of their team and influenced objectives at service level.

• Good collaborative partnership working by services across the trust with external stakeholders ensured that services could be shaped to meet local needs.

• The trust had a number of ways to involve people with lived experience, carers, staff and the public in the work and direction of the care delivery services. Training and support was provided to enable people to have a voice and get involved.

• The trust had systems for identifying risks and the mitigation of these, though some further alignment and strengthening of these to ensure that it was clear how local risks were monitored and planned for at trust level.

• The trust had systems to manage information securely. Staff at different levels of the organisation were able to access the data they needed to deliver services and gain assurance. Further work was needed to ensure all staff were updating their ‘my learning’ supervision and training record to ensure this reflected what was happening at local level and provide ongoing assurance to the board.

Checks on specific services

Wards for older people with mental health problems

Good

Updated 7 June 2019

Sussex Partnership NHS Foundation Trust provides wards for older people with mental health conditions who are admitted informally or detained under the Mental Health Act 1983.

To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led?

Where we have a legal duty to do so, we rate the quality of services against each key question as outstanding, good, requires improvement or inadequate.

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

Where necessary, we take action against registered service providers and registered managers who fail to comply with legal requirements, and help them to improve their services.

At the last comprehensive inspection of this core service in October 2017, we rated the wards as good for the five key questions (safe, effective, caring, responsive and well-led). We re-inspected all five key questions during this inspection.

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

  • The service provided safe care. The ward environments were safe and clean. The wards had enough nurses and doctors. Staff assessed and managed risk well. They minimised the use of restrictive practices, managed medicines safely and followed good practice with respect to safeguarding
  • Staff developed a holistic, recovery-oriented care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the patients and in line with national guidance about best practice. Staff engaged in clinical audit to evaluate the quality of care they provided.
  • The ward teams included or had access to the full range of specialities required to meet the needs of patients on the wards. Managers ensured that these staff received training, supervision and appraisal. The ward staff worked well together as a multi-disciplinary team and with those outside the ward who would have a role in providing aftercare.
  • Staff understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity and understood the individual needs of patients. They actively involved patients, families and carers in care decisions.
  • The service managed beds well in most wards and many patients were discharged once their condition warranted this.
  • The service was well led and the governance processes ensured that ward procedures ran smoothly.

However:

  • Although we concluded that staff actively involved patients in their care, on St Raphael ward the plans did not contain patients’ preferences including their likes and dislikes around their care. Also, there were no accessible or easy read care planning tools available for patients who might need them on most wards including St Raphael, Opal and Brunswick wards.
  • Due to high demand for admissions, patients on Heathfield ward did not always have beds available to them when returning from leave.
  • Heathfield and St Raphael wards had shared sleeping arrangements where more than one patient had to sleep in the same bedroom. The four dormitories on Heathfield ward had only one sink each.
  • The dining room on Grove ward was very enclosed and was not decorated in dementia friendly colours.

Forensic inpatient or secure wards

Good

Updated 7 June 2019

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

  • We rated four key questions as good (Safe, Effective, Caring and Well-led) and one key question as outstanding (Responsive).
  • The service provided safe care. The ward environments were safe and clean. The wards had enough nurses and doctors and ward managers could adjust the staffing levels based upon the acuity on the wards. Staff assessed and managed risk well. They minimised the use of restrictive practices, managed medicines safely and followed good practice with respect to safeguarding.
  • Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the patients and in line with national guidance about best practice.
  • The ward teams included or had access to the full range of specialists required to meet the needs of patients on the wards. Managers ensured that these staff received training, supervision and appraisal. The ward staff worked well together as a multi-disciplinary team and with those outside the ward who would have a role in providing aftercare.
  • Staff planned and managed discharge well and liaised well with services that would provide aftercare.
  • The service was well led and the governance processes ensured that ward procedures ran smoothly.

However:

  • Not all patients prescribed high dose antipsychotic medicine had their physical healthcare appropriately monitored. High dose antipsychotic medication is medicine that is prescribed in excess of the upper limits recommended by the British National Formulary
  • Fir ward at The Chichester Centre was storing patient bank cards and money in the medicine cupboard temporarily. This was inappropriate and posed a risk to the security of the cards. The service immediately rectified the issue when we highlighted it to them.
  • Ash and Hazel wards had items in their clinic rooms that were past their ‘use by’ date. These included oral syringes, urinalysis test strips and disposable tourniquets. This was immediately rectified when highlighted to the service.
  • On two wards, staff were not ensuring that medicines were stored at the correct temperature. Fir ward’s fridge temperature was consistently recorded as above eight degrees celsius whilst storing patient medicines. This posed a risk to the efficacy of the medicines. This was immediately rectified when highlighted to the service who moved the medicine into a different medicine fridge. The trust advised us that this was a recording error by staff reading the thermometer temperatures. Additionally, Hazel ward’s clinic room was consistently recorded as above the maximum temperature threshold stated in trust policy. The ward had ordered an air conditioning unit and the pharmacy team reduced the medicine expiry dates in accordance with trust policy in response to the raised temperatures.

Mental health crisis services and health-based places of safety

Requires improvement

Updated 7 June 2019

Our rating of this service went down. We rated it as requires improvement because:

  • We had very significant concerns about the crisis team based at Millview.
  • The amount of medical cover varied across services as most of the consultants worked part time. Staff told us that there were sometimes problems because the junior doctors that provided cover were sometimes reluctant to prescribe medicines because they didn’t know the patients.
  • There was evidence that the low morale, resistance to change and culture of the crisis team at Mill View Hospital was having a negative impact on the care and treatment that some patients received. Care plans and risk assessments were not kept up to date to ensure patients were receiving the care and treatment they needed.
  • The care records reviewed across the four teams varied with respect to their quality and level of detail. The risk assessments and care plans at Meadowfield, Chichester and Langley Green were comprehensive, holistic and recovery orientated. At Mill View, of the six risk assessments reviewed, one had no risk assessment and five contained limited information that did not accurately reflect the current clinical presentation of the patient. In four of the six records reviewed care plans were missing in two of these patients with high risk and complex needs were identified. The remaining two records that had care plans, were not holistic and did not reflect the full range of needs of the patients. Staff did not always act on review of overdue care plans that had been flagged on the whiteboard. An investigation into a serious incident at Mill View in December 2017 had identified the lack of a crisis personalised care plan as a contributory factor. The investigation into the incident recommended that all patients should have an individualised care plan in place by March 2019.
  • Staff from the places of safety did not always record the time that the approved mental health professional and section 12 doctor had been requested. This meant that the nurse could not accurately calculate the time from request to completion of assessment.
  • Staff told us that there were sometimes delays in accident and emergency due to a place of safety not being available, approved mental health professionals and police said there were sometimes delays in identifying an available place of safety because of the referral process involved a pager, which then delayed a response to initial contact. Staff said that because ambulances did not always meet the trust policy’s agreed response time, an alternative health ambulance company was used to transport patients to the place of safety.

However:

  • Staffing numbers were based on caseload and patient needs. Managers used regular bank staff who knew the patients and service well. The service provided mandatory training in key skills to all staff and made sure everyone completed it.
  • Staff discussed risks and safeguarding concerns during regular handovers. Staff held meaningful discussions and spoke about patients in a respectful and caring manner. Staff had access to psychiatrists, to ensure all risks from patients on their caseload were safely managed. Staff saw all patients daily for the first three days and then reviewed frequency of visits. We saw evidence that staff saw patients twice a day where risk was considered high.
  • There was a range of disciplines in the crisis teams which included doctors, nurses, psychologists, occupational therapists and social workers. All staff we spoke with were appropriately experienced and qualified to meet the needs of patients.
  • Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned. The trust sent a bulletin to all staff with information about recent incidents and any learning identified. Staff had access to debrief sessions after serious incidents that were facilitated by senior managers and psychologists.
  • We saw effective multi-agency working with a variety of services including the police, ambulance services, approved mental health professionals, rapid response team, street triage and in-patient wards.
  • Patients at Langley Green could access the day service for daily group therapy in a range of psycho-social interventions Monday to Friday. Groups offered included mindfulness, managing anxiety and art therapy.
  • We observed staff from the mental health telephone service who were supportive, kind and caring in their conversations with callers.
  • Patients from the crisis teams spoke positively about the support they had received. They said that staff were responsive, listened and were easy to talk to and they had found the support invaluable. People who had used the places of safety said that staff had treated them with kindness and respect and had done their best to make them feel comfortable.
  • The trust had introduced initiatives including a pilot to improve the referral process in Chichester and the introduction of an early discharge nurse to bridge the gap between wards and the crisis teams.
  • An urgent care lounge had recently been opened at Langley Green to provide a calm environment for patients waiting to be assessed. The trust planned to open a psychiatric decision unit at Mill View in April 2019 which will cover the whole of the county.
  • The managers and team leaders demonstrated the skills, knowledge and experience to perform their roles. All leaders showed a good understanding of the service and could clearly explain how to provide high quality care.
  • A lead nurse for quality and compliance had been in post since October 2018. They were responsible for standardising processes and improving services to patients in the places of safety. Staff reported an improvement in clinical practice and cascading information since they had been in post.

Community-based mental health services for adults of working age

Good

Updated 23 January 2018

Our rating of this service improved. We rated it as good because:

  • There were sufficient numbers of staff in each team. Staff vacancies were low and were covered by appropriate use of bank or agency staff. Team leaders reviewed caseloads regularly with practitioners to ensure these were manageable.
  • Staff could access a consultant psychiatrist for routine or urgent appointments.
  • We reviewed 51 care records of people using services. Staff had completed a risk assessment for each at the point of initial assessment. Staff updated risk assessments regularly and after each reported incident. Each team had a duty system to respond to changes in risk or deterioration in the health of people using services.
  • Staff had completed safeguarding training and demonstrated good awareness of safeguarding issues. Teams within West Sussex and Brighton and Hove had integrated social workers who took the lead role in any safeguarding inquiry. Within East Sussex the social workers were co-located which helped facilitate communication with the local authority.
  • All staff knew how to report an incident on the trust reporting system. Staff received feedback and learning from incidents at team meetings and via the trust patient safety matters newsletter. We saw evidence of a change in practice following incidents which resulted in more joined up care for people using services.
  • All care records of people using services we reviewed had a comprehensive needs assessment. Assessments were person centred, holistic and recovery focused. Care plans reflected the needs identified in the initial assessment.
  • The early intervention service had a physical health champion to ensure staff were meeting the physical health needs of people using the service, and over 90% of all people using the service had received their annual physical health screening.
  • Staff monitored the effects of medicine on the physical health of people using services and reviewed this regularly in physical health clinics. This was in line with guidance from the National Institute for Health and Care Excellence.
  • The trust had a duty of candour policy to which staff adhered. This ensured that staff were open and transparent with those using services and their families and carers and kept them informed of any incidents that might have affected them. The duty of candour policy clearly set out the steps staff must take when informing others following an incident.
  • Teams offered a variety of treatment options to people using services including National Institute for Health and Care Excellence approved interventions such as family therapy for those experiencing psychosis and cognitive behavioural therapy for anxiety and depression. Each team was multidisciplinary and included nurses, doctors, social workers, psychologists and occupational therapists as well as peer support workers.
  • Staff received regular supervision in a variety of ways. Staff could access clinical, management and peer supervision as well as reflective practice sessions and support from risk circles. Annual appraisals were completed or booked and staff reported these were meaningful and appropriate to their role.
  • All teams had good relationships with other teams within, and external to, the organisation. We saw good evidence of joined up working between crisis services, inpatient services and the community teams. Staff had good links with the local authority and teams in West Sussex and Brighton and Hove had employed social workers.
  • People using services reported that staff treated them kindly, with respect and maintained their dignity. Staff worked with people using services to help them understand their condition so that they could manage these themselves more effectively.
  • We saw evidence in care records of involvement of the people using services in their care planning. Care records showed that staff discussed care plans with those using services and offered them a copy of their care plan.
  • Carers we spoke with told us they were kept informed and up to date with any changes in the care for the person receiving the service. Carers were invited to attend review meetings and care programme approach meetings.
  • The trust had a set target time for referral to assessment and referral to treatment times. Each service across the trust was meeting these timescales. Each team had a duty system which could see urgent referrals on the same day, or within five days as appropriate. All routine referrals were seen within 28 days.
  • The Glebelands service had developed an integrated service with people using services and non-statutory organisations in the area called the Pathfinder Alliance. This was a co-production between the trust, people using services and the third sector and was only one of three in the country.
  • The Ifield Drive service had developed a service to provide mental health support to armed services veterans. The service could take referrals directly from veterans, or from their GP. The service aimed to support veterans transition into civilian life and had specialist practitioners who had an understanding of military culture and what the veterans may have been through.
  • Staff provided people using services with information on how to make a complaint as part of the initial information pack. People using services told us they knew the process for how to make a complaint.
  • All services had a wide range of rooms to see people using services, including clinic rooms. These were all soundproofed to maintain confidentiality. Each waiting area had a suitable supply of information on local community groups, advocacy and medicine information.
  • There were clearly defined roles for team leaders and service managers within each team inspected. Team leaders demonstrated a clear understanding of the service they were providing and how it connected to the wider community service.
  • All staff we spoke with said they felt proud to work for the team they did, and all emphasised the strong working relationships in the teams. There was an open culture of honesty amongst the practitioners and all staff felt they could offer constructive challenge to one another.
  • The trust was involved in numerous pieces of research for people using services, their carers and staff. Staff were encouraged to be involved in service development and quality improvement work.

However:

  • Staff at Linwood did not follow the trust lone working policy. Staff at Linwood made arrangements to buddy up with another practitioner at the start of each day. This meant that no one practitioner had oversight of these arrangements. We raised this with the trust during the inspection who gave us assurances that they would ensure staff at Linwood followed the lone working policy.
  • Not all mandatory training was up to date across all teams. We raised this with the trust who provided a plan for when this would be completed.
  • Staff did not always record on the electronic system why a care plan may not have been provided to the person using services. Some care plans for people using services were detailed in consultant letters, but this was not always recorded.

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

Good

Updated 23 January 2018

Our rating of this service improved. We rated it as good because:

  • All wards were clean, well-furnished, and were accessible with a number of disabled adapted rooms on each ward with adapted accessible bathrooms.
  • Staff carried out comprehensive assessments and physical health assessments with all patients following their admission.
  • The trust was a smoke-free environment and staff supported patients with smoking cessation groups, use of ecigarettes, and nicotine replacement therapy.
  • We spoke with 58 patients during our inspection and all said they found staff to be kind, polite and treated them with respect. Staff interacted with patients in a caring, supportive, and compassionate way and respected the personal needs of patients from the lesbian, gay, bisexual, transgender community.
  • All wards held monthly carers’ support groups. Ward managers made contact with carers and ensured they were supported to contribute to their family members’ treatment by attending reviews and commenting on care plans. Wards had family rooms to ensure that patients could meet with family, children and friends.
  • All wards had psychologists and occupational therapist input. Occupational therapists offered daily schedules of activities for patients including art, cookery, pottery, music appreciation, table tennis, exercise, smoothie making sessions, pamper sessions, games, mindfulness, movie and pizza nights. Patients in Langley Green Hospital were able to spend time with a therapeutic dog who visited with a volunteer during the week.
  • The trust held an award ceremony in November 2017 to recognise and award staff members for outstanding contributions in their work. The Langley Green Hospital team won a gold award for the significant and continued improvements being made to patient care across all areas of the hospital. The matron at Langley Green Hospital won a gold award for being an amazing role model to both staff and patients, for being an inspiring nurse and for leading their team from the front with humility, tenacity and commitment. Coral Ward in Langley Green Hospital won a silver award for work undertaken to champion physical health through the National Early Warning Score policy and safety book.
  • The service manager at Langley Green Hospital implemented the ‘Leader Leader’ model at the end of 2016. This model encouraged staff and patients to adopt leadership roles in the everything they did, for example nursing staff and patients contributed towards ward improvement initiatives.

However:

  • The trust did not ensure that premises and equipment were always well maintained. Staff on Woodlands ward did not always complete environmental risk assessments for the month of September, nor did they use a check list to conduct assessments when they were undertaken. There was an uncovered gap in a window on Amber ward when it was open. The seclusion room on Amber ward did not allow clear observation, did not have closed circuit television, and the two-way communication intercom was broken at the time of our visit. We re-visited the seclusion room in December 2017 and found that the room had been closed so that renovation works could take place. Staff in Meadowfield Hospital did not regularly check their resuscitation equipment weekly in April, May and August 2017 and Rowan ward during June, July, August and September 2017 on Maple ward.
  • The service’s compliance for mandatory and statutory training as of 31 July 2017 was 86%, however four courses did not achieve the trust target of 85%.
  • We found that some patient paperwork was incomplete. One out of six risk assessments we reviewed on Maple ward had not been updated to include risks from numerous incidents involving a patient in September 2017. On Rowan ward, one out of 17 patients’ medicine records we reviewed noted that staff did not record physical health observations post administration of rapid tranquilisation as the patient was ‘volatile’. On Maple ward there was no record that physical health observations were carried out for one patient who received rapid tranquilisation. The trust implemented a new non-contact physical observation post rapid tranquilisation protocol immediately after our inspection. This provided staff with clear guidelines and recording materials for use during non-contact observations.
  • Medicine records across all the wards were generally well completed. However, on Rowan ward six out of 17 records contained recording errors. All of these issues had been addressed when we reviewed the records during a visit in December 2017. Not all care records for patients in Woodlands Hospital, Caburn, and Maple wards had been updated following incidents and not all care records on Rowan ward were personalised and recovery focussed.
  • Staff completed a physical health care plan for each physical health condition patients presented with to ensure they received appropriate care. On Rowan ward we found that two out of six physical health care plans were incomplete. On Woodlands ward one out of five physical health care plans we reviewed did not include details of a patient’s physical health issue requiring treatment.
  • Not all staff received regular supervision or annual appraisals.

Specialist community mental health services for children and young people

Good

Updated 23 January 2018

Our rating of this service improved. We rated it as good because:

  • One domain was rated as outstanding (Caring) and four domains were rated as good (Safe, Effective, Responsive and Well-Led).
  • The service had addressed and managed the concerns raised at the last inspection.
  • Clinician’s caseloads were continually monitored and managed. Risk to patients on waiting lists was well managed and mitigated.
  • All patients entering the service had thorough risk assessments and management plans in place. There were excellent safeguarding policies, procedures and lead practitioners in the service.
  • Supervision was happening regularly in line with trust policy. On inspection, we saw that supervision completion rates were much higher than data submitted and had significantly improved since the last inspection.
  • The service appropriately monitored and managed patients physical health needs. We witnessed excellent working relationships with partner agencies to arrange for further physical health testing when required. Multidisciplinary and interagency working across the service was excellent. We saw the service engaging with many partner agencies to benefit their patients.
  • The service delivered a range of evidence-based specific treatment pathways and therapeutic interventions for patients.
  • We observed many positive and engaging interactions between staff and patients and staff demonstrated a caring attitude towards patients. Patient and carer feedback on staff attitudes was excellent. Patients and carers felt involved with the delivery of their care and felt that their voice was heard.
  • The service provided an advice consult experience (ACE) for patients and carers to join and become involved in service projects and give feedback on staff recruitment panels.
  • The service delivered a variety of additional campaigns, workshops, events and support groups to equip patients and carers with skills and tools to deal with their mental health in the community, reduce stigma and encourage social interaction.
  • Sites were within target times for assessment, except for the Hampshire locations where we saw clear and effective plans in place to reduce the waiting times. The service was on average within national target times for referral to treatment.
  • The service was managing the risk of their waiting lists well and were constantly engaging with patients, parents and carers to assess any changes in circumstances and risk. There was a consistent and effective approach across the service to dealing with crisis and emergency situations.
  • There was clear leadership direction from senior members of staff within the service with sufficient leadership training and opportunities for all staff. Staff were extremely proud to work in the service and for the trust and morale was generally high amongst all staff.
  • The service undertook a variety of staff wellbeing activities and days to support staff wellbeing and contribute towards the services recruitment and retention plan.
  • Local management and systems of supervision and appraisals was appropriate and monitored regularly at all locations. There were regular audits in place to monitor for regularity and quality of supervision by senior leadership.
  • Innovation within the service was excellent. The service had a culture of driving positive change from the bottom.
  • Front-line staff had the confidence, support and encouragement to suggest and try new ideas.

However:

  • There were no alarm systems in place for Chichester and not all therapy rooms had alarms in Eastleigh. Staff did not carry personal alarms at either of these sites.
  • Not all patient risk assessments were updated within six months, as per trust policy. We found this in 13% of the care records we reviewed.
  • As at December 2017 the core service was just below the trust’s target for mandatory training (at 84% compared to the target of 85%) and five mandatory training courses were below 75% completion. The service submitted an action plan to us which showed how they planned to ensure all staff completed mandatory training by March 2018.
  • Some sites did not have enough therapy rooms. This impacted on the delivery of care at one location where appointments were either not being made, shortened or cancelled at the last minute.

Community-based mental health services for older people

Good

Updated 23 December 2016

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

  • Staff were providing a safe service. Staff were aware of the risks for individual people who used the service, medication was managed well and staff had a good understanding of safeguarding. Staff were able to see people who used the service in a timely manner and prioritised people who needed urgent support.

  • Practice reflected current guidance and there was good access to a wide range of interventions. There was good use of outcome measures to monitor if services were effective. Audits that were specific to the service were carried out to provide assurances of robust care with improvements made where needed.

  • Staff were consistently caring and showed warmth, kindness and respect to people who used services and their carers. They provided practical and emotional support. Staff went the extra mile to care for people in a person centred way and involve carers and people who use the service in their care. Groups and accessible information was provided for people and carers. The needs of carers were assessed and support groups were provided.

  • Staff morale was good. They were well supported with access to training and other opportunities to reflect and learn. There were opportunities for leadership training and career progression.

  • The teams worked well with GPs, the local authorities and other local services and groups.

  • People who used the service, carers, staff and external stakeholders were encouraged to give feedback through a range of mechanisms and these were used to make improvements.

Long stay or rehabilitation mental health wards for working age adults

Good

Updated 23 December 2016

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We rated long stay/rehabilitation wards for adults of working age as good overall because:

  • Clincal risk was well managed with risk assessments reviewed and updated in ward round meetings. Environmental risks were identified and addressed regularly and managers ensured that environmental risk assessments were regularly undertaken. These were shared with staff in monthly meetings. There weresystems in place for sharing information with staff around lessons learned

  • the average Patient Led Assessment of the Care Environment score for cleanliness across all services was 93%; with three of the services scoring 100%

  • staff on all wards provided patients with a full and comprehensive programme of therapeutic, recovery focussed activities and interventions. Activity plans were patient led and designed around personal needs and choices. All of the services promoted and encouraged positive risk taking within their ethos and actively supported patients towards independence.

  • there were enough staff to provide patients with regular 1:1 time and staff informed us that leave was not cancelled because of staffing levels. Patients confirmed that leave was regularly facilitated

  • overall compliance with mandatory training for the services was 81%. This was higher than the trust compliance rate of 65% - 75% in all areas of mandatory training

  • staff completed comprehensive assessments for all service users in a timely manner. All 30 care records we reviewed were up to date, personalised, holistic and recovery orientated. Records showed that patients had ongoing physical health monitoring, using national early warning scores needs and this was recorded in patient notes.

  • we observed positive therapeutic relationships between staff and patients at all wards and we observed strong local leadership across the wards, which staff and patients confirmed.

Child and adolescent mental health wards

Good

Updated 23 December 2016

We rated child and adolescent mental health wards as good because:

  • Families, carers, and most young people spoke positively about those that cared for them. They told us that staff listened to them and informed and involved them in decisions about care and treatment. Care plans reflected this and were very holistic and personalised. Staff gave young people copies of their care plan. Carers told us that the consultant and other staff were accessible. They provided weekly updates and information to help the carer understand the current situation of the young person and their treatment. Staff made changes to the running of the unit in response to the views and opinions expressed by young people.

  • The unit provided young people with a range of activities and therapies. Young people on the unit had access to occupational therapists and psychologists. Staff also worked collaboratively with local authorities and community services to better understand and meet the range and complexity of the needs of young people.

  • Staff spoke enthusiastically about their roles and displayed a passion to meet young people’s needs. Staff demonstrated an empathy and understanding about the young people’s varying circumstances and a commitment to offering a professional, accountable service with a real desire to see young people move on in their lives.
  • Managers supported staff to develop and improve. Staff had good access to specialised training and received regular supervision and a yearly appraisal.
  • The unit was well-led. Staff felt supported by their managers and staff morale was good. Staff told us that managers were approachable and supported them to develop their role further. Carers spoke very highly of the leadership within the unit and felt this had an impact with the whole team. Carers told us that the unit had improved significantly over the past year.

However:

  • There was not always regular staff members on shift during the night.
  • There was a Mental Health Act Review visit in February 2016 that identified areas of improvement that needed to be addressed. An action plan for these improvements had been put in place.

Wards for people with a learning disability or autism

Good

Updated 23 December 2016

At our last inspection in January 2015, we found the service required improvement. Since the last inspection the service had improved. This time we rated wards for people with learning disabilities or autism as good because:

  • Staff supported patients in a safe ward, which was clean.They identified risks in the ward and developed plans to keep patients safe.

  • Staff completed full assessments for patients, which included their individual needs and risks.They used these assessments and worked with patients to develop individualised care plans, which followed professional guidance.

  • Staff used safe techniques when restraining patients and reviewed incidents of restraint to see if they could support patients in a less restrictive manner in the future.

  • The ward multi-disciplinary team had an appropriate range of professional skills to meet patients’ needs. Staff worked well as a team and felt well supported.

  • Staff supported patients in a kind and considerate manner, whilst maintaining their privacy and dignity. We observed staff being very supportive to patients.The feedback we received from patients and their carers was positive. Staff involved people in the care they received.

  • The service had clear systems for reviewing quality information and implementing learning.Staff reported when things went wrong and investigated these incidents to identify how they could improve in the future. Staff had developed and completed improvement action plans following our last inspection, which rated the service requires improvement.During this inspection we found staff had implemented necessary changes and made many improvements.

Community mental health services with learning disabilities or autism

Good

Updated 23 December 2016

We rated community mental health services for people with learning disabilities as good because:

  • The trust maintained safe staffing levels across teams. Turnover, sickness and vacancy rates were low in the teams we inspected. The trust managed vacancies pragmatically when they arose by discussing the needs of each team and varying staff skills accordingly. Staff in all teams were highly skilled, qualified and enthusiastic about their work. Staff accessed specialist training to improve their skills. Staff morale was high and all staff reported feeling supported by their team, local management and trust management.

  • Staff completed thorough risk assessments and reviewed risk appropriately. Risk assessments covered all areas. Staff reported manageable caseload numbers across all teams we inspected. Staff raised safeguarding alerts to the local authority competently and knew what to report.

  • Multidisciplinary and interagency working was excellent. We saw initiatives to improve working with mental health teams, dementia teams, social care and child and adolescent teams. We saw interagency working to promote the Transforming Care Agenda 2015. This aims to improve services for people with a learning disability and a mental health problem or behaviour that challenges. Staff promoted joint working agreements with relevant teams to prevent admission to hospital for people using the service. Staff provided high quality training packages to other teams and providers to raise awareness of learning disability issues and to improve care in these areas.

  • The service worked effectively with people who found it hard to engage. They provided bespoke packages of care to enable people to live in the community who may otherwise be in hospital.

  • Staff treated people using the service with respect and sensitivity. Staff really cared about the people they worked with. People using the service and their carers spoke positively about staff and the service they provided. The trust employed therapy assistants to ensure all staff and providers worked effectively with people with learning disabilities. All locations were accessible for people with physical disabilities and all locations provided easy read signage. Information, reports and care plans were all available in easily accessible formats.

  • The trust was committed to research and evidence based practice. Staff were proactive at trying out new initiatives and being involved in research and development.

However:

  • Staff did not complete crisis plans routinely. These plans inform people using the service and their carers who to contact or what measures to take in a crisis.

  • Staff reported incidents but did not always learn lessons from the investigations of these incidents. This meant services missed opportunities for improvement.

  • The trust recently introduced the electronic database, care notes. However, the trust had not implemented standard operating procedures. As a result, different teams and staff from different disciplines recorded information in different formats and in different sections. This meant it was not easy to find information in the notes as individuals recorded things differently.

  • Teams did not use outcome measures to monitor effectiveness and progress of interventions.

  • The teams did not routinely ask people using the service to complete satisfaction surveys. This meant that the teams missed opportunities to improve services in response to feedback.