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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.

Reports


Inspection carried out on 29th January to 28th February 2019

During a routine inspection


CQC inspections of services

Service reports published 7 June 2019
Inspection carried out on 29th January to 28th February 2019 During an inspection of Wards for older people with mental health problems Download report PDF | 472.17 KB (opens in a new tab)Download report PDF | 1.84 MB (opens in a new tab)
Inspection carried out on 29th January to 28th February 2019 During an inspection of Forensic inpatient or secure wards Download report PDF | 472.17 KB (opens in a new tab)Download report PDF | 1.84 MB (opens in a new tab)
Inspection carried out on 29th January to 28th February 2019 During an inspection of Mental health crisis services and health-based places of safety Download report PDF | 472.17 KB (opens in a new tab)Download report PDF | 1.84 MB (opens in a new tab)
See more service reports published 7 June 2019
Service reports published 23 January 2018
Inspection carried out on 2 Oct to 7 Dec 2017 During an inspection of Community-based mental health services for adults of working age Download report PDF | 530.14 KB (opens in a new tab)Download report PDF | 2.8 MB (opens in a new tab)
Inspection carried out on 2 Oct to 7 Dec 2017 During an inspection of Acute wards for adults of working age and psychiatric intensive care units Download report PDF | 530.14 KB (opens in a new tab)Download report PDF | 2.8 MB (opens in a new tab)
Inspection carried out on 2 Oct to 7 Dec 2017 During an inspection of Specialist community mental health services for children and young people Download report PDF | 530.14 KB (opens in a new tab)Download report PDF | 2.8 MB (opens in a new tab)
Inspection carried out on 2 Oct to 7 Dec 2017 During an inspection of Wards for older people with mental health problems Download report PDF | 530.14 KB (opens in a new tab)Download report PDF | 2.8 MB (opens in a new tab)
See more service reports published 23 January 2018
Service reports published 23 December 2016
Inspection carried out on 6, 7 and 12 - 16 September AND 7 December 2016 During an inspection of Specialist community mental health services for children and young people Download report PDF | 367.01 KB (opens in a new tab)
Inspection carried out on 12 - 16, 29 September, 1 - 4 November 2016 During an inspection of Acute wards for adults of working age and psychiatric intensive care units Download report PDF | 397.85 KB (opens in a new tab)
Inspection carried out on 12 – 16 September 2016 During an inspection of Mental health crisis services and health-based places of safety Download report PDF | 413.61 KB (opens in a new tab)
Inspection carried out on 12 - 16 September 2016 During an inspection of Forensic inpatient or secure wards Download report PDF | 307.33 KB (opens in a new tab)
Inspection carried out on 12 - 16 September 2016 AND Focussed inspection from 1 – 4 November 2016 During an inspection of Wards for older people with mental health problems Download report PDF | 336.36 KB (opens in a new tab)
Inspection carried out on 12 - 16 September 2016 During an inspection of Community-based mental health services for older people Download report PDF | 331.33 KB (opens in a new tab)
Inspection carried out on 12 - 16 September 2016 During an inspection of Long stay or rehabilitation mental health wards for working age adults Download report PDF | 305.23 KB (opens in a new tab)
Inspection carried out on 20 September 2016 During an inspection of Child and adolescent mental health wards Download report PDF | 296.48 KB (opens in a new tab)
Inspection carried out on 12 - 16 September 2016 During an inspection of Community-based mental health services for adults of working age Download report PDF | 361.27 KB (opens in a new tab)
Inspection carried out on 13 September 2016 During an inspection of Wards for people with a learning disability or autism Download report PDF | 289.46 KB (opens in a new tab)
Inspection carried out on 12 -16 September 2016 During an inspection of Community mental health services with learning disabilities or autism Download report PDF | 323.59 KB (opens in a new tab)
See more service reports published 23 December 2016
Service reports published 24 March 2016
Inspection carried out on 25-26 January 2016 During an inspection of Wards for older people with mental health problems Download report PDF | 253.85 KB (opens in a new tab)
Inspection carried out on 2 Oct to 7 Dec 2017

During a routine inspection

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

  • We rated safe, effective, responsive and well-led as good, and caring as outstanding. We also took into account the current ratings of the seven services not inspected this time.
  • We rated the four core services of acute wards for adults of working age and psychiatric intensive care units; wards for older people with mental health problems; community-based mental health services for adults of working age; and specialist community mental health services for children and young people as good. We had rated all of these as requires improvement at the previous inspection; which demonstrated clear improvements had taken place across the services.
  • The adult social care location at Avenida Lodge was rated good.
  • We rated well-led at the trust level as good. The senior leadership team changes had brought with it a new, invigorated and open approach to the direction of the trust and culture in which the staff worked. Staff were excited about the changes and empowered to make improvements to their services. Staff felt valued and felt proud to work for the organisation and engaged effectively with managers.
  • The management of waiting times had improved. Teams used innovative ways to monitor and manage risks of adults and young people on the waiting lists.
  • Patients and carers all gave positive feedback about the care they received. They said they were involved in decisions about their care and that staff considered their well-being and experiences as a patient, as well as their physical health needs.
  • There was improved sharing of when things had gone wrong and learning from incidents across the trust.

However:

  • Improvements were needed to ensure that the premises and equipment were safe at all times across the acute wards for adults of working age and psychiatric intensive care units.
  • The adult social care location at Lindridge was rated as requires improvement.
  • There were some gaps in the staff understanding of their responsibilities under the Mental Capacity Act 2005.
  • There were some mandatory training subjects that did not meet the trust’s compliance target of 85%.
  • The trust was still in the process of implementing its action plan to ensure that serious incident investigations were completed to the timelines within their policy.
  • The trust needed to make some improvements to ensure that evidence of occupational health screening for all executive and non-executive directors was obtained.
  • There was more work to do to ensure the trust data management systems accurately reflected the supervision and appraisals that were taking place in services.
  • Although patients leave from the wards was managed well, feedback from the approved mental health professionals was that there was not always a bed immediately available to patients recently detained under the Mental Health Act.

Inspection carried out on 4-5 April 2017

During a routine inspection

The service had taken most of the action that we required them to take following the September 2016 inspection. The most notable exception was that the trust had not ensured that all staff had undertaken mandatory training.

We found the following issues that need to improve:

  • All staff had access to mandatory training. However this core service did not meet the trust’s own 75% mandatory training compliance target in four out of 22 subjects. The trust monitored training through a RAG (red, amber green) rating scale to monitor progress across all mandatory training subject areas for all trust services.

  • Wards generally followed National Institute for Health and Care Excellence guidance and the trust’s rapid tranquilisation policy when monitoring patients’ physical health after administration of rapid tranquilisation. However there were gaps on three physical health monitoring records across Coral, Amber and Pavilion wards, so these did not demonstrate that these checks had been carried out.

  • Although medicines management practice was generally satisfactory across all of the wards, on Amber ward an audit carried out in March 2017 indicated that in 33 (48%) of the medicine administration charts there was an error.

  • Eleven out of 12 wards we inspected demonstrated learning from incidents. However, a patient had set fire to their room on Woodlands ward in December 2016. During our inspection we observed patients of Woodlands using their own cigarette lighters smoking in the courtyard. Staff we spoke with told us they did not encourage or enforce patients to hand in lighters following leave from the ward, or carry out searches, which did not demonstrate learning from this incident. Of all the wards we visited, Woodlands ward was the only one that had not implemented the trust smoke-free and smoking cessation policy, in place since 8 March 2017.

  • The seclusion room on Amber ward in Langley Green Hospital did not have a mirror or closed circuit television to enable staff to monitor the blind spots in the room. The seclusion room mattress could be used by patients to block the window or the door. However, the trust had a plan in place to renovate this seclusion room.

  • Staff on Maple ward did not record what patients were wearing prior to them leaving the ward on escorted or unescorted leave. This could have assisted staff to identify a patient if they went absent without leave in the community. This was a recommendation in the trust’s leave of absence policy.

However, we also found the following areas of good practice:

  • The wards had good observation policies and procedures to minimise risks to the safety of patients. Risk assessments and risk monitoring of patients had improved and was good across all the wards.

  • All 12 wards had developed detailed ligature risk assessments that clearly identified the risk areas and mitigation in place to minimise risks. A ligature point is anything which could be used to attach a cord, rope or other material for the purpose of hanging or strangulation. All wards developed a risk footprint ward map. These maps were colour coded to indicate the risks in the environment, such as ligature points and levels of staff observations required in these areas to maintain patient safety.

  • All 12 wards were generally clean, well furnished and well maintained. Wards carried out regular infection control and prevention audits. The clinic rooms across all the wardswere clean, fully equipped with functioning equipment and emergency medicines.

  • The trust undertook a focussed recruitment drive and wards across the core service were becoming permanently staffed. All ward managers told us that they were able to increase staffing levels daily to meet the changing needs of the patient groups across the wards, for example when there was increased risks and need for increased patient observations.

  • Staff told us that there was adequate medical cover on all wards day and night to attend quickly if there was a medical emergency.

Inspection carried out on 6, 7, 12 – 16, 20, 22, 29 September 2016 AND Focused follow up inspections: 1 – 4 November AND 7 December 2016

During a routine inspection

We rated Sussex Partnership NHS Foundation Trust as requires improvement because:

  • At the last comprehensive inspection of the trust in January 2015 we identified a number of areas where improvements were needed across a number of core services, with five of the 11 core services rated as requires improvement.

  • At this inspection four core services were rated as requires improvement. There were ongoing concerns in the acute wards for adults of working age and psychiatric intensive care units, and wards for older people with mental health problems. Physical health monitoring was not taking place following the intramuscular administration of rapid tranquillisation andpatients were prescribed high dose antipsychotics. On the acute wards for adults of working age and psychiatric intensive care units we also identified concerns in relation to the Mental Health Act records and consent to treatment. In the specialist community mental health services for children and young people we identified that there was a lack of risk assessments for some children and young people using the service. This had been identified at the January 2015 inspection and a requirement notice issued. This was an ongoing issue and so we took enforcement action through serving two Warning Notices on the trust to ensure that action was taken to improve these services.

  • Some areas identified at the previous inspection still needed to be improved upon from the January 2015 inspection, such as access to psychological therapy for all patients. Progress had been made across the trust to meet the Department of Health guidance on eliminating mixed-sex accommodation. However, on wards for older people with mental health problems there were mixed-sex wards that were not always managed in accordance with Department of Health guidance on mixed-sex accommodation, though risks were being mitigated on a day-to-day basis.

  • Within the community services there were long waiting times from assessment to treatment within the specialist community mental health services for children and young people, with Hampshire and Kent as the services with the longest waiting times.

  • There was a high level of bed occupancy across the acute wards for adults of working age and psychiatric intensive care units. Patients did not always have a bed to return to following a period of leave and patients were sometimes moved to other wards for non-clinical need, due to the pressures on beds.

  • The governance processes had undergone a review and the changes as a result of this were still embedding. As a result of this the systems did not provide sufficient oversight to the board around clinical risks, such as physical health care and medicines optimisation to ensure that patients were not at risk of insufficient care and treatment. It was also unclear how findings from staff surveys, clinical audits and national enquiries were being used to develop the trust.

However:

  • At this inspection seven core services were rated as good, which was an improvement on the six rated good following the January 2015 inspection. Three core services had moved from being rated as requires improvement to good at this inspection. These were the ward for people with a learning disability or autism, the long stay/rehabilitation mental health wards for working age adults and the child and adolescent mental health ward.

  • Since the last comprehensive inspection of the trust the trust had developed and implemented an action plan for improvement. During this inspection we found that the majority of actions had been implemented and many improvements made to services and people’s experiences of these. This was particularly noticeable in the ward for people with a learning disability or autism at the Selden Centre and long stay/rehabilitation mental health wards for working age adults, where a number of improvements had been made to make the services safer and enhance the experience of patients.

  • Since the last inspection in January 2015 the trust had improved staffing levels to ensure that wards were safely staffed. The majority of staff were caring, kind and respectful towards patients, people who use services and their carers, involving them in decisions about their care. This had an impact on the care planning which, where in place, was generally good.

  • Since the last inspection the trust had improved access to physical healthcare and this was kept under regular review. Most areas had access to good physical healthcare support to meet patients’ needs.

  • The trust had clear information about the cultural diversity of populations across the different areas they served and they sought feedback about people’s experience of the care they received and future priorities. The trust had a clear strategy and initiatives to improve people’s experience.

  • The trust had a patient advice and liaison service that offered advice and support to people wanting to make a complaint.

  • The trust responded positively and proactively to concerns identified during the inspection and made marked improvements to the services to ensure patients were kept safe from the risks of medicines.

  • The trust had met the fit and proper persons test and there was very positive feedback about the leadership of the trust. The chief executive had had a positive impact on making staff feel more engaged and improving the culture of the trust. Staff felt positive and incorporated the trust values into their work.

  • From the 1 - 4 November 2016 we carried out a focussed inspection to follow up the Warning Notice served on the acute wards for adults of working age and psychiatric intensive care units, and wards for older people with mental health problems. At this inspection we identified that the trust had responded positively to the findings in the Warning Notice and significant improvements had been made. The trust had developed an action plan and staff were well aware of this and what they needed to do. The wards were being supported by senior managers, peer review and practice development nurses. The e-learning for physical health monitoring had been updated and all staff were receiving refresher training. The records we viewed showed that consent to treatment paperwork was recorded appropriately. The records relating to physical health monitoring for patients prescribed high dose antipsychotics and following intramuscular administration of rapid tranquillisation medicines demonstrated this was being carried out.

  • On the 7 December 2016 we carried out a focussed inspection to follow up the warning notice served on the specialist community mental health services for children and young people. At this inspection we identified that the trust had responded positively to the findings in the warning notice and significant improvements had been made. The trust had developed an action plan to ensure compliance with the trust target of 95% of risk screens completed. We looked at a random selection of 127 care records from 19 teams across Hampshire, Kent and Sussex. Out of the 127 care records we found only 4 risk screenings were missing, this equated to a 97% compliance rate for the records looked at. The trust target was 95%. This demonstrated a significant improvement from our findings in September 2016, where we found only 43% of risk screens having been completed.

Inspection carried out on 12 – 16 January 2015

During a routine inspection

Overall, we rated the trust as requires improvement and this was because;

  • Two core services were rated as inadequate under safe.
  • The trust had no plan in place to tackle the high rate of suicide.
  • There were significant gaps in the flow of information, particularly around learning from serious untoward incidents.
  • There were significant gaps in training, appraisal and supervision for some staff.
  • The quality of care planning was inconsistent and did not always demonstrate how people were involved in their care.
  • The trust lacked strategic direction.
  • The trust had gaps in relation to providing the board with assurance

However, caring in some areas was rated as outstanding and the trust is a place of innovation and ideas. It also clearly aspires to best practice in many parts of the services provided.

There were inconsistencies in how services were managed and we found that some areas of care in learning disability and older people's inpatient services were inadequate. These services require urgent attention to bring them up to acceptable standards of safety. We asked the trust to close Hanover Crescent (part of their rehabilitation services) to admissions due to an unsafe environment, with poor conditions of hygiene and low levels of staffing. The trust did this immediately.

It was clear that the trust recognised that some areas are facing particular challenges and we found the managers and directors of the service were responsive to our challenge and acted swiftly to put things right.

We have recommended a number of requirement notices to be put into force and these relate to ensuring that standards of hygiene are maintained, that staff are properly supported to receive their mandatory training, that risks are properly identified and that care plans involve people.

There was an elevated risk of people self-harming or committing suicide. Many of these deaths happened whilst people were in receipt of services in the community.

There was an elevated risk of suicide within 3 days of discharge and within 3 days of being admitted to an acute setting. In total there were 80 deaths in the period from 1 November to 31 October 2014. Whilst we recognise that it is not just the trust's responsibility to develop a suicide prevention plan, we would urge the trust to initiate urgent work with public health and community agencies to address this.

We were concerned that staff were not receiving timely feedback in relation to serious untoward incidents. We therefore asked the trust to supply us with details of length of time it took from notification of a serious untoward incident to time the report and action was completed and circulated. From the data supplied to us from the trust, it is struggling to meet timescales, with some investigations taking 220 days from start to finish. This may impact on their ability to close the loop on serious incidents and ensure that learning to avoid / prevent similar incidents from emerging is shared. The current average time taken to

of completed reports of

from serious untoward incidents is about four

approx. 4 months. The trust must work to address this.

The staff survey identified that there was an elevated risk to staff working extra hours and feeling stressed. The trust has a clear action plan to address this. This includes reviewing the staffing levels and skills mix on inpatient units and reviewing the use of three

-day 12 ½ hours shift rotas.

At the time of the inspection, the Trust acknowledged that there was not a system in place to clearly identify clearly where ‘agency’ staff were used. The Trust raised this with CQC prior to the inspection.

Overall, caring was rated as good, achieving outstanding in community child and adolescent services and forensic services. This was because staff were found to be compassionate, kind and motivated to go an extra mile for the people they served. We also found good solid evidence that the trust was sensitive to individual needs, taking cultural, religious and spiritual needs into account. They also provided good information to people and this was available in a variety of languages and formats.

The trust is a place where innovation is given priority and this enables them to seek new ways of working and bring about change to service delivery. There is much creativity at a senior level. We would urge the trust to continue to ensure that the quality of more traditional services is

are maintained and that the desire to seek new and innovative ways of working is not at the expense of those services.

The senior management team were very positive about the new Chief Executive Officer (CEO). They felt that having been through a difficult and challenging period and that the culture of the board had changed for the better. We found the senior team to be open and transparent in their discussions with us. The CEO was able to describe the challenges facing Sussex.

It was clear that the trust were in a period of some significant change, including a cultural change. We heard from staff and stakeholders that relationships at times with the trust had been difficult to manage at times but that this was becoming more positive. Many felt that the new CEO was responsible for bringing in a more visible and open approach. The trust did not have a clear strategic direction that

which was written down and understood by staff. The trust also lacked a framework to

which ensured that the board were clear about and understood the more detailed risks and challenges facing the organisation. It had identified the principal

principles risks faced by the organisation.

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.


Reports under our old system of regulation (including those from before CQC was created)


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.