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Provider: Cheshire and Wirral Partnership NHS Foundation Trust Good

Reports


Inspection carried out on 7 August to 20 September 2018

During a routine inspection

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

  • We rated well-led for the trust overall as good. The trust board and senior leadership team had the appropriate range of skills, knowledge and experience to perform its role and the non-executive directors provided robust and constructive challenge to the trust board. The trust board and leadership team demonstrated a high level of integrity. High priority was placed on doing the right thing for patients, staff and the organisation as a whole.
  • We rated effective and well led as good, safe as requires improvement and caring as outstanding. In rating the trust, we took into account the previous ratings of the services we did not inspect this time.
  • We rated 14 of the trust’s 15 services as good overall, and one as outstanding overall.
  • The rating for safe and well led for community health services for children, young people and families had improved from requires improvement to good. The rating for caring had improved from good to outstanding.
  • Leaders were visible in the service and approachable for patients and staff. Staff felt supported by their managers and felt they could raise concerns or approach managers for support.
  • The trust’s strategy, vision and values underpinned a culture that was person centred. There was a strong commitment to patient and carer involvement.
  • Staff completed thorough assessments of patients’ needs, including physical health and mental health assessments.
  • Care was provided that was in line with national guidance and staff were skilled to deliver care.

However:

  • We rated safe as requires improvement in four of the 15 services. Ratings in the safe domain for child and adolescent mental health wards and wards for older people with mental health problems went down from good to requires improvement.
  • Generally, staff felt well supported and many said they had clinical supervision. However, there was no trust target for clinical supervision and recorded rates were low.
  • In some services, compliance rates for mandatory training were below the trust target.
  • There had been no qualitative audits of staff practice in relation to seclusion and rapid tranquilisation. In one service, physical health checks following rapid tranquilisation had not been carried out in line with trust policy. In another service, there were gaps and shortfalls in seclusion records.


CQC inspections of services

Service reports published 4 December 2018
Inspection carried out on 7 August to 20 September 2018 During an inspection of Child and adolescent mental health wards Download report PDF | 442.7 KB (opens in a new tab)Download report PDF | 2.76 MB (opens in a new tab)
Inspection carried out on 7 August to 20 September 2018 During an inspection of Wards for older people with mental health problems Download report PDF | 442.7 KB (opens in a new tab)Download report PDF | 2.76 MB (opens in a new tab)
Inspection carried out on 7 August to 20 September 2018 During an inspection of Community health services for children, young people and families Download report PDF | 442.7 KB (opens in a new tab)Download report PDF | 2.76 MB (opens in a new tab)
Inspection carried out on 7 August to 20 September 2018 During an inspection of Acute wards for adults of working age and psychiatric intensive care units Download report PDF | 442.7 KB (opens in a new tab)Download report PDF | 2.76 MB (opens in a new tab)
Inspection carried out on 7 August to 20 September 2018 During an inspection of Forensic inpatient or secure wards Download report PDF | 442.7 KB (opens in a new tab)Download report PDF | 2.76 MB (opens in a new tab)
See more service reports published 4 December 2018
Service reports published 3 February 2017
Inspection carried out on 10 October 2016 During an inspection of Forensic inpatient or secure wards Download report PDF | 308.79 KB (opens in a new tab)
Inspection carried out on 11 October 2016 During an inspection of Substance misuse services Download report PDF | 290.07 KB (opens in a new tab)
Inspection carried out on 10 and 11 October 2016 During an inspection of Community-based mental health services for adults of working age Download report PDF | 245.58 KB (opens in a new tab)
Inspection carried out on 10 October 2016 During an inspection of Specialist community mental health services for children and young people Download report PDF | 245.95 KB (opens in a new tab)
Inspection carried out on 10-11 October 2016 During an inspection of Acute wards for adults of working age and psychiatric intensive care units Download report PDF | 359.36 KB (opens in a new tab)
Inspection carried out on 10 & 11 October 2016 During an inspection of Community-based mental health services for older people Download report PDF | 245.98 KB (opens in a new tab)
See more service reports published 3 February 2017
Service reports published 3 December 2015
Inspection carried out on 22 to 26 June 2015 During an inspection of Community-based mental health services for adults of working age Download report PDF | 363.86 KB (opens in a new tab)
Inspection carried out on 22-26 June and 6 July 2015 During an inspection of Forensic inpatient or secure wards Download report PDF | 347.59 KB (opens in a new tab)
Inspection carried out on 22 - 26 June 2015 During an inspection of Wards for people with a learning disability or autism Download report PDF | 308.32 KB (opens in a new tab)
Inspection carried out on 23 June 2015 During an inspection of Wards for older people with mental health problems Download report PDF | 297.01 KB (opens in a new tab)
Inspection carried out on 23 June – 24 June 2015 During an inspection of Long stay or rehabilitation mental health wards for working age adults Download report PDF | 319.01 KB (opens in a new tab)
Inspection carried out on 23 - 26 June 2015 During an inspection of Community health services for children, young people and families Download report PDF | 344.8 KB (opens in a new tab)
Inspection carried out on 22 to 26 July 2015 During an inspection of Community mental health services with learning disabilities or autism Download report PDF | 265.3 KB (opens in a new tab)
Inspection carried out on 24 and 25 June 2015 & 7 July During an inspection of Mental health crisis services and health-based places of safety Download report PDF | 385.43 KB (opens in a new tab)
Inspection carried out on 23-25 June 2015 During an inspection of Acute wards for adults of working age and psychiatric intensive care units Download report PDF | 391.93 KB (opens in a new tab)
Inspection carried out on 23 June 2015 During an inspection of Child and adolescent mental health wards Download report PDF | 297.76 KB (opens in a new tab)
Inspection carried out on 23-24 June 2015 During an inspection of Community-based mental health services for older people Download report PDF | 295.39 KB (opens in a new tab)
Inspection carried out on 24 and 25 June 2015 During an inspection of Specialist community mental health services for children and young people Download report PDF | 317.29 KB (opens in a new tab)
Inspection carried out on 23 - 26 June 2015 During an inspection of End of life care Download report PDF | 275.93 KB (opens in a new tab)
Inspection carried out on 23 - 26 June and 1 July 2015 During an inspection of Community health services for adults Download report PDF | 337.39 KB (opens in a new tab)
See more service reports published 3 December 2015
Inspection carried out on 23-26 June 2015

During a routine inspection

When aggregating ratings, our inspection teams follow a set of principles to ensure consistent decisions. The principles will normally apply but will be balanced by inspection teams using their discretion and professional judgement in the light of all of the available evidence.

We found that the provider was performing at a level that led to a rating of ‘Good’ because;

  • The trust was committed to and working towards reducing restrictive practices in line with their trust-wide campaign ‘zero harm’, which started in July 2014. The campaign focusses on encouraging staff to ‘Stop, Think and Listen’ and to continually reflect and review their everyday working life to identify possible practices that could result in unwarranted harm to patients. However, in the low secure forensic services, there were a number of restrictive practices not based on clinical risk.

  • The trust had worked hard to improve staffing levels significantly over the six months to June 2015 although it continued to face staffing challenges on some wards. Overall, we found staffing levels were safe. Caseloads across the community teams were in line with current guidance.

  • The trust was committed to improving the quality of services and had governance structures to support that aim Morale was good across services, and staff teams were motivated and committed to providing good care and treatment to patients in line with the trust’s vision and values. This was shown through a number of initiatives staff had implemented to improve outcomes for patients and carers. We noted several examples of good practice where staff teams had ‘gone the extra mile’ to ensure patients’ needs were being met.

  • The trust board and senior managers we spoke with were open and transparent. They recognised areas that needed to be improved in addition to areas that were working well. There was a positive culture of learning and continuous improvement. When we raised concerns to the trust board about care in Saddlebridge Recovery centre during the inspection, they were very open in their responses and provided assurance that the issues we raised would be managed effectively.

  • The trust acknowledged that there were some difficulties with their current information technology (IT) system, which had been escalated onto the board assurance framework risk register with actions to deal with them.

  • We identified a number of issues regarding the way the trust dealt with complaints but the trust was aware of them and already had plans to manage complaints more effectively.

However;

  • Some of the seclusion rooms did not comply with the Mental Health Act Code of Practice and some staff were not following trust policy and national guidance in relation to the use of seclusion rooms.

  • Some of the acute mental health wards did not fully comply with the Department of Health required guidance on same-sex accommodation.

  • In some services, individual patient risks were not always reviewed and updated in a timely manner and environmental risks were not always identified and mitigated.

  • Within community (physical health) services for children and young people, the service did not maintain accurate, complete and contemporaneous records in respect of each service user. Records were not accessible to authorised people as necessary in order to deliver care and treatment in a way that meets their needs and keeps them safe.

  • Compliance with mandatory training and appraisal of work performance was variable across services.

  • Issues that had previously been raised through Mental Health Act monitoring visits in relation to patients detained under the Act had not been fully dealt with by the trust.

  • Compliance with the Mental Capacity Act 2005 (MCA) was variable across the trust. Although we found good practices in relation to the MCA in some services, in others staff lacked confidence in assessing patients’ capacity to make decisions about their care and did not feel that the current e-learning training sufficiently enabled them to develop their skills and confidence in this area.

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.


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.