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Provider: South West Yorkshire Partnership NHS Foundation Trust Good

Inspection Summary


Overall summary & rating

Good

Updated 23 August 2019

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

  • We rated effective, caring, responsive and well-led as good, and safe as requires improvement. We rated 12 of the trust’s 14 services as good and two as requires improvement. In rating the trust, we took into account the previous ratings of the 10 services not inspected this time.
  • Although we still rated the acute wards for adults of working age and psychiatric intensive care units core service as requires improvement we could see areas of improvement. We improved the overall ratings for two of the four core services inspected. We rated the community-based mental health service for adults of working age as good for all five key questions.
  • The trust board and senior leaders had the appropriate range of skills, knowledge and experience to perform their role. The trust had a clear vision and set of values which were embedded and respected across the organisation.
  • Leadership development opportunities were available, including opportunities for staff below team manager level. The leadership and management development offer to staff took an inclusive approach, the pathway was open to both registered clinicians and non-registered support staff.
  • The trust’s target rate for appraisal compliance was 95%. At the time of inspection, the overall appraisal compliance rate was 97%. The appraisal process was aligned to the trust values and staff spoke positively regarding this process. On the whole staff felt respected, supported and valued within their teams.
  • The trust had a policy on restrictive practices which had recently been introduced. Each ward now had a reducing restrictive practice log/risk assessment which recorded the local restrictions in place, and what the risk assessment was with and without each restriction in place, what the decision was, and the plan for review of any restrictive practice. This had helped services identify and reduce restrictive practices across the inpatient wards.
  • On the whole, across the core services, we observed staff to be kind and caring towards patients. We observed positive relationships and could see staff knew the patients well.

However:

  • We rated acute wards for adults of working age and psychiatric intensive care units as requires improvement overall. Although we could see areas of improvement since our last inspection the core service still rated requires improvement for the safe, effective, caring and well led key question.
  • Children and young people were waiting over 18 weeks to receive treatment in some areas. Across the service four team’s referral to treatment times exceeded 18 weeks. There were significant delays in accessing assessment for children and young people with autism spectrum disorder in all locations that offered this service.
  • Although staff reported feeing respected, supported and valued amongst their local team and most by the senior managers. Two groups of staff felt they were not valued by senior leadership.

Inspection areas

Safe

Requires improvement

Updated 23 August 2019

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

  • Staff did not always complete and update risk assessments on acute wards for adults of working age and psychiatric intensive care services, wards for older people with mental health problems and specialist community mental health services for children and young people.
  • Medicine management of as required medication was not always reviewed in line with good practice. Staff did not consistently undertake the required physical health monitoring following rapid tranquilisation.
  • Not all patients had easy access to nurse call alarms. Where bedrooms did not have nurse call alarms, the trust had a protocol in place that sought to ensure patients had access to alarms, for example if they had limited mobility, were vulnerable to abuse, felt isolated, or had limited ability to communicate. However, this was not consistently implemented or interpreted across all the wards.

However:

  • All clinical premises where people received care were safe, clean, well equipped, well furnished, well maintained.
  • Staff understood how to protect patients from abuse and exploitation and services worked well with other agencies to do so. Staff had training on how to recognise and report abuse, and they knew how to apply it.
  • Services managed patient safety incidents well. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with whole teams and the wider service. When things went wrong, staff apologised and met requirements of the duty of candour.

Effective

Good

Updated 23 August 2019

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

  • Staff provided a range of treatment and care for the patients based on national guidance and best practice. They ensured that patients had good access to physical healthcare and supported patients to live healthier lives.
  • Most teams had access to the full range of specialists required to meet the needs of patients under their care. With the exception of the older adult wards where staff did not all have specialist dementia training, managers made sure that staff had a range of skills needed to provide high quality care. They supported staff with appraisals, supervision and opportunities to update and further develop their skills. Managers provided an induction programme for new staff.
  • Staff from different disciplines worked together as a team to benefit patients. They supported each other to make sure patients had no gaps in their care. The teams had effective working relationships with other relevant teams within the organisation and with relevant services outside the organisation.
  • Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice.
  • In specialist community mental health services for children and young people staff supported patients to make decisions on their care for themselves proportionate to their competence. They understood how the Mental Capacity Act 2005 applied to young people aged 16 and 17 and the principles of Gillick competence as they applied to people under 16. Staff assessed and recorded consent and capacity or competence clearly for children or young people who might have impaired mental capacity or competence.

However:

  • On acute wards for adults of working age and psychiatric intensive care units care records did not consistently consider the full range of patients’ needs and not all reflected the patient’s voice. Care plans in the wards for older people with mental health problems were not always personalised.
  • On wards for older people with mental health problems staff described the challenges of managing a ward with a mix of organic and functional patients. The quality of dementia care was inconsistent.

Caring

Good

Updated 23 August 2019

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

  • Feedback from patients and carers was positive. In the patient friends and family test the trust had scored between 85 and 95 percent in the 12 months prior to inspection.
  • Most staff treated patients with compassion and kindness, staff understood individual needs of patients and involved patients and those close to them in decisions about their care.
  • In the specialist community mental health service for children and young people, patients and their families or carers had opportunities to be involved in decisions about the service.

However:

  • On acute wards for adults of working age and psychiatric intensive care units, some staff did not always treat patients with compassion and kindness and could act in an abrupt way. Staff did not always respect patients’ privacy as they did not always knock when entering bedrooms.

Responsive

Good

Updated 23 August 2019

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

  • Service treated concerns and complaints seriously, investigated them and learned lessons from the results, and shared these with all staff.
  • In community services, referral criteria did not exclude people who would have benefitted from care. On the wards for older people with mental health problems staff managed beds well and there was a clear admissions criteria and pathways.
  • In the specialist community mental health service for children and young people, the service had identified issues with long waiting lists and delivered low level interventions to those waiting when appropriate. Staff recommended counselling and groups, both internal to the trust and provided by external partners, to support children and young people and their families or carers while waiting.
  • On inpatient wards, patients had their own bedroom and were able to personalise them. There was access to quiet space.
  • Services met the needs of all patients including those with a protected characteristic. Staff helped patients with communication, advocacy and cultural and spiritual support.

However:

  • Children and young people were waiting over 18 weeks to receive treatment in some areas. Across the service four team’s referral to treatment times exceeded 18 weeks. There were significant delays in accessing assessment for children and young people with autism spectrum disorder in all locations that offered this service. On acute wards for adults of working age and psychiatric intensive care units bed occupancy was high. This meant that a bed was not always available when needed. There were high numbers of patients readmitted after being discharged.
  • On wards for older people with mental health problems access to garden space on Willows ward was restricted and signage on some wards was not dementia appropriate.

Well-led

Good

Updated 23 August 2019

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

  • The Trust Board and leadership team had the appropriate range of skills, knowledge and experience. The Trust leadership and Board showed integrity on an ongoing basis. They had a comprehensive knowledge of current priorities and challenges and took action to address them. At the time of inspection, 19% of the board were from Black and minority ethnic backgrounds. The leadership structure had been reviewed since our last inspection and now included a director who had responsibility for operations and a director of provider development. The leadership for acute inpatient areas had also been reviewed to include matrons we could see how this had impacted positively in services.
  • There was a robust and realistic strategy for achieving trust priorities and developing good quality, sustainable care. There were effective internal governance structures, systems and processes in place to support delivery of the strategy. Staff, patients, carers and external partners had the opportunity to contribute to discussions about the strategy and the trust were committed to place-based work which supported partnership working.
  • Leadership development opportunities were available, including opportunities for staff below team manager level. Included in the offer the trust had several targeted programmes that met the identified needs of staff from under-represented groups, including moving forward which was specifically in place to support staff from minority communities. The offer took an inclusive approach that identified leadership was not role specific.
  • The trust had a clear vision and set of values with quality and sustainability as the top priorities. Staff showed good knowledge and understanding of the trust vision and values and these were embedded across the organisation.
  • The trust provided a range of wellbeing support for staff. The occupational health team had introduced a proactive process to support staff to manage distress caused by a work incident and the trust was promoting the #allofus campaign which promoted supporting the wellbeing of all.
  • The trust had appointed a freedom to speak up guardian and provided them with sufficient resources and support to help staff to raise concerns. One freedom to speak up guardian had five hours dedicated time each week and there was a network of three additional guardians. Although the trust felt the dedicated time had an impact and enabled the freedom to speak up role and function to develop, a business case had been approved by senior leaders for a half time secondment to a freedom to speak up guardian lead post.
  • The trust was actively engaged in collaborative work with external partners, such as involvement with sustainability and transformation plans. The trust had involvement in a number of partnership alliances across the different locations and had involvement with two integrated care systems. The trust chief executive officer was the lead executive for the West Yorkshire health and care partnership.

  • The trust senior leadership team oversaw the equality, diversity and inclusion agenda within the trust. In April 2019 it made the equality, diversity and inclusion forum a sub-committee of the trust board. There was a strong governance structure around the agenda. The trust has developed an equality and diversity strategy and work programme and there was evidence of engagement across the trust involving staff and service users. However, some staff felt whilst there was strong leadership at board level, there were some areas of middle management which lacked awareness and understanding of Black minority ethnic and Workforce Race Equality Standard issues. The trust was undertaking a Building Leadership For Inclusion action research programme particularly focused at this management level.
  • A clear framework set out the structure of the service team, division and senior trust meetings containing three lines of assurance. Leaders used meeting agendas to address quality and sustainability at all levels across the trust. The trust had recently completed the implementation of an electronic clinical record system. They were proud of the success of the delivery of this significant change management programme which had strong oversight from both the quality and audit committees, although they recognised there was more to do, embedding the system and maximising the benefit of its functionality.
  • The trust actively sought to participate in national improvement and innovation projects and was actively participating in clinical research studies. External agencies recognised the trust’s improvement work. The trust was awarded NHS Standards of Procurement – Level 1 status and retained their Customer Service Excellence accreditation.

However:

  • During core service inspections, we found breaches of regulation 12 relating to the completion of risk assessment documentation. We found concerns on the acute wards for adults of working age and psychiatric intensive care units, on wards for older people with mental health problems and at the specialist community mental health services for children and young people. We were concerned the trust did not have oversight of this risk and assurance that patients’ risks were always been captured with risk management plans in place.
  • Although the complaints system had space to record a communication plan, no information was recorded for any of the complaints we reviewed during inspection. Three of the six complaints we reviewed fell outside of the trust’s 40-day response target.
  • Achievement of the financial plan in the current year was predicated on the delivery of a large cost improvement programme of over £10m. This was not fully identified at the time of the inspection. The trust should address this to ensure delivery of the financial plan. The board had made a positive start in getting to grips with the challenge of financial sustainability, but this work needed to move at pace to deliver a credible plan moving forward.
Checks on specific services

Mental health crisis services and health-based places of safety

Good

Updated 24 June 2016

We rated South West Yorkshire NHS Partnership Foundation Trust as good because :

  • The environment of the health based places of safety (136 Suites) were adequate and in line with Mental Health Act guidance. It optimised patient dignity, safety and comfort.

  • The crisis teams had robust monitoring of medication and had rapid access to psychiatry; patients could be seen within the day. We saw examples of the crisis team learning from incidents and implementing changes within their practice. Staff across all the teams were up to date in their adult and child safeguarding training.

  • All the teams worked alongside external stakeholders to respond to people in crisis effectively. This was in line with the trust’s responsibilities under the crisis concordat.

  • All initial assessments are carried out by a band 5 or band 6 nurse. If a band 5 nurse carries out the initial assessment, this is always discussed with a band 6 nurse. We saw initial assessments were comprehensive and detailed. Staff across all the teams had a good understanding of the Mental Health Act and Mental Capacity Act. They understood the guiding principles and were able to give examples of how they could apply it in practice.

  • We observed meaningful, compassionate and person centred care delivered by dedicated staff. Patients were positive about their experiences with the crisis teams.

  • Staff within the crisis teams met their targets to complete initial assessments within four hours of referral. We observed flexible working around patients’ needs. Staff adjusted their schedules so that patients could attend their appointments. Crisis teams utilised a range of resources which increased the quality of the service they delivered, for example, self-help leaflets and interpreting services.

  • We saw effective use of auditing which provided oversight of team performance. These enabled team leaders to plan work and identify gaps. We saw teams shared good practice across the different regions, learning from each other’s experiences. Staff had good morale and were happy about how they were managed. Staff felt valued and that their thoughts mattered.

However,

  • We saw that the staff on the 136 suites did not always review their ligature risk assessments in a timely manner.

  • Monitoring for Mental Health Act and Mental Capacity Act training were not always present.

  • Appraisals for staff had not been completed equally across the four crisis teams.

  • Not all teams provided crisis team leaflets describing their crisis service other than in English.

  • Not all teams were commissioned to have police liaison officers.

  • The crisis team in Barnsley had high levels of sickness. The sickness levels year to date was 12%.

  • Teams felt less confident with the management structure above the team leaders.

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

Requires improvement

Updated 23 August 2019

  • The assessment of and management of patient risk was not consistent. The ward acuity was high and there was high rates of staff assaults. There were omissions in medicine management surrounding the review of ‘as required’ medication and physical health monitoring after rapid tranquilisation. Short shelf life medicine did not have a date of opening. Monitoring of emergency equipment was not consistently completed. Not all patients were able to summon assistance using a nurse call alarm if they needed to.
  • Care assessments did not always consider the full range of patients’ diverse needs or evidence patient involvement.
  • There were times when people did not feel well-supported or cared for. Nine patients we spoke to described staff as sometimes “rude” or “abrupt”. Staff did not consistently knock before entering patient bedrooms and patient confidentiality was not maintained on some wards.
  • Bed occupancy was high and staff reported a pressure to admit patients despite voicing concerns about clinical risk. Patients were occasionally placed on an unsuitable ward or an air bed. Not all wards provided activities seven days a week.
  • Clinical and internal audit processes were inconsistent in their impact and errors had been found in documentation of important clinical documents such as seclusion and Mental Capacity Act. Staff morale was mixed. Staff did not always raise concerns or suggestions as they did not feel they would be heard or that any action would come from it.

However:

  • The environment was clean and well maintained. Some wards had implemented measures to reduce restrictive practice and staff used restraint and seclusion appropriately. Safeguarding was given sufficient priority and staff adhered to the duty of candour. There was evidence of investigations following serious events, lessons learnt were shared and duty of candour was well embedded. Staffing levels had been increased following work with NHSI. Staff could access specialist training to reflect the needs of the client group.

  • Patients had a prompt physical health assessment on admission and monitoring though admission. The ward teams 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 multidisciplinary team and with those outside the ward who would have a role in providing aftercare. Some wards had AIMS accreditation. Staff had good understanding of their responsibilities under the Mental Health Act 1983.

  • Interactions we observed were largely positive. Staff demonstrated a good knowledge of each patient. All carers we spoke with were involved in patient care. Patients and carers were able to feed back about the ward and have a say about their treatment options.

  • The facilities allowed for a diverse activity programme, including tai chi and hydrotherapy. Patients enjoyed the food and accommodation. Patients had access to advocates, interpreters and pastoral care. Complaints and concerns were investigated and findings shared.

  • Ward managers were knowledgeable and capable, committed to improve the quality of care for patients and involved in research projects. The modern matron post was giving wards the authority to implement change. There was good learning and support across and within the business delivery units. Staff had opportunities for development and career progression.

Wards for older people with mental health problems

Good

Updated 23 August 2019

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

  • The service had enough nursing and medical staff to deliver care and keep people safe from avoidable harm. Staff assessed patient and environmental risks and responded to changes in that risk. Staff reported adverse incidents and learnt from when things went wrong.
  • Staff assessed the physical and mental health needs of patients on admission and worked collaboratively to meet patient need. Patients had access to a range of professionals as part of their care. Staff were supported with regular supervision and annual appraisal.
  • Staff treated patients and carers with kindness and respect. Patients and carers were able to give feedback on the care and treatment they received. Patients and carers we spoke with were positive about staff and the service.
  • There were clear admission criteria and processes. Staff managed beds well. Patients had access to a range of facilities and information. Staff were responsive to patient needs, including those with a protected characteristic.
  • Staff considered managers to be supportive and described an open and honest culture. Governance systems and processes allowed staff to assure the quality of care and generate improvements. Managers were aware of the challenges the service faced and had plans to address them. Staff had been involved in an ongoing service transformation project.

However:

  • Staff described challenges in managing a mix of organic and functional patients and signage on some wards was not dementia appropriate.
  • Staff did not always review the use of as required and covert medication.
  • Risk assessments were not always comprehensive or completed in a timely manner. Care plans were not always personalised and did not always evidence patient involvement.
  • Wards did not have access to dedicated psychology input.

Community-based mental health services for adults of working age

Good

Updated 23 August 2019

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

  • The service had enough staff, who knew the patients and received basic training to keep patients safe from avoidable harm. The number of patients on the caseload of the teams, and of individual members of staff, was not too high to prevent staff from giving each patient the time they needed.
  • Staff understood how to protect patients from abuse and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse, and they knew how to apply it.
  • Staff provided a range of treatment and care for the patients based on national guidance and best practice. They ensured that patients had good access to physical healthcare and supported patients to live healthier lives.
  • Staff from different disciplines worked together as a team to benefit patients. They supported each other to make sure patients had no gaps in their care. The teams had effective working relationships with other relevant teams within the organisation and with relevant services outside the organisation.
  • Staff treated patients with compassion and kindness. They understood the individual needs of patients and supported patients to understand and manage their care, treatment or condition.
  • The service was easy to access. Its referral criteria did not exclude patients who would have benefitted from care.
  • The service had made significant progress towards reducing the waiting list times for access to psychological therapies. Although, continued to have some patients who had been waiting for an average of 174 weeks.
  • Leaders had the skills, knowledge and experience to perform their roles, had a good understanding of the services they managed.
  • Staff felt respected, supported and valued. They reported that the provider promoted equality and diversity in its day-to-day work and in providing opportunities for career progression. They felt able to raise concerns without fear of retribution.

However:

  • Following the migration to the new electronic patient records system we found information relating to patients’ risk assessment and care plans was not easily available and, in many cases, information had been transferred in to different areas of the new system.
  • Resuscitation bags at Drury lane had not been checked for two weeks resulting in the airway aids been out of date.
  • Staff in Barnsley and Kirklees told us they did not find senior managers to be visible within the service.

Specialist community mental health services for children and young people

Requires improvement

Updated 23 August 2019

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

  • Staff did not always assess or manage risk well. Staff did not follow up on all identified risks, create management plans or appropriate crisis plans. The service did not actively monitor children and young people on waiting lists to detect and respond to increases in level of risk.
  • Children and young people were waiting over 18 weeks to receive treatment in some areas. Across the service four team’s referral to treatment times exceeded 18 weeks. There were significant delays in accessing assessment for children and young people with autism spectrum disorder in all locations that offer this service. Children and young people on waitlists did not have a formal care plan until they received intensive treatment. For those admitted into the service care plan entries were written from a clinical perspective, more so than for the individual receiving treatment.
  • Staff did not always record consent clearly for children or young people in their care records.
  • Staff did not ensure that children and young people and their families and carers had access to all the information they should. This included information on complaints, carers assessments and LGBTI support.
  • Issues relating to on-call provision were not yet fully resolved. There were staffing gaps in the rotas as there were not enough staff to cover all responsibilities.
  • Staff did not always follow systems and processes for cleaning and checks of clinical equipment. The Barnsley service did not have CQC ratings from the previous inspection displayed in patient areas.

However;

  • Clinical premises where children and young people were seen were safe and clean. The number of children and young people on the caseload of the teams, and of individual members of staff, was not too high to prevent staff from giving people using the service the time they needed. Staff ensured that children and young people who required urgent care were seen promptly.
  • The service had identified issues with long waiting lists for intensive treatment and gaps in commissioning and were working to resolve these. When appropriate, they provided low level interventions to those waiting for intensive treatment. They were implementing new service models to better meet the needs of people using the service and were working with commissioners to get additional funding and a clear service specification.
  • Staff developed holistic, recovery-oriented care plans informed by a comprehensive assessment and in collaboration with families and carers. They provided a range of treatments that were informed by best-practice guidance and suitable to the needs of children and young people. Staff engaged in clinical audit to evaluate the quality of care they provided.
  • The teams included or had access to the full range of specialists required to meet the needs of those using the service. Managers ensured that these staff received training, supervision and appraisal. Staff worked well together as a multidisciplinary team and with relevant services outside the organisation.
  • Staff understood the principles underpinning capacity and competence in line with the Mental Capacity Act and Gillick competence.
  • Staff treated children and young people with compassion and kindness, respected their privacy and dignity, and understood their individual needs. They actively involved children, young people and their families and carers in care decisions.
  • The service was easy to access in terms of referrals and initial assessment. Staff assessed and were able to expedite treatment for children and young people who required urgent care promptly. The criteria for referral to the service did not exclude children and young people who would have benefitted from care.
  • The service was well led, and the governance processes ensured that procedures relating to the work of the service ran smoothly.

Wards for people with a learning disability or autism

Good

Updated 3 July 2018

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

  • The trust had acted upon our feedback from our previous inspection of this service and there had been overall improvements in the safety of patient care.
  • Following our previous inspection, the ward had taken action to reduce blanket restrictions. However, there was no system or process that supported how staff identified and reviewed blanket restrictions and some blanket restrictions remained.
  • Staff had a culture of openness and honesty and safety was a high priority for all staff. Managers monitored the safety and quality of the service and took action to improve safety. Staff regularly assessed and monitored risks to patients, to protect them from avoidable harm and abuse.
  • Patients received effective care and treatment. Staff planned and delivered care and treatment that was in line with current evidence based standards and best practice. Training for the Mental Health Act and Mental Capacity Act was now mandatory for all staff. Staff completed care plans that were holistic, personalised, and involved patients in decisions about their care and treatment.
  • Staff provided person-centred care that patients’ needs and treated patients with dignity and respect. Feedback we received from people who used the service was overall positive and we observed staff who were kind, caring, and respectful. However, we had concerns about the limited opportunities for patient feedback and carer support on the ward.
  • The ward had a clear pathway that provided flexibility for staff to deliver care that met the needs of individual patients. Staff planned and managed admissions and discharges to the ward so that patients had timely access and successful discharges from the ward. The facilities promoted the comfort, dignity and privacy of patients and the ward planned to make further improvements to the environment.
  • The ward needed to make further improvements in the arrangements for reviewing blanket restrictions and obtaining the views of people who used the service. However, staff morale was overall positive about managers who were highly visible and supportive. Senior staff were knowledgeable about the ward and committed to making continuous improvements.

Forensic inpatient or secure wards

Good

Updated 3 July 2018

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

  • The services had a clear leadership and governance structure. Systems and processes enabled senior leaders to have oversight of performance and areas that required improvement. The services had clear embedded pathways for care and treatment across the medium and low secure services. When serious incidents occurred, the trust ensured that these were investigated and frontline staff received information on lessons learnt.
  • Newhaven ward had a specialist forensic outreach nurse to facilitate discharge and provide short-term support after discharge. The services had no delayed discharges and no readmissions within 28 days.
  • The service had made improvements in the training compliance rates of Mental Health Act and the Mental Capacity Act. Most staff now had a reasonable understanding of their responsibilities.
  • Physical health care was easily accessible and embedded into patients’ care and treatment well.
  • Staff ensured patients had access to therapies and activities to promote their care and treatment on the wards, within the services and at the recovery college. The services had sufficient space to facilitate sessions and activities. The service ran a number of events for patients and carers.
  • Staff involved patients in their care and treatment. They treated patients with respect and provided support. Care plans were written in easy read format and alternative languages.

However:

  • Patients did not routinely have access to a nurse call system but staff ensured on an individual basis that alarms were in place when required.
  • Thornhill and Johnson wards had some issues with safe medicines management in relation to equipment, temperatures, secure storage and administration recording. Ryburn and Newhaven wards could not raise an external staff response quickly if required.
  • The trust had a timescale to replace door handles that could be used as a ligature anchor point.
  • Feedback from staff reported difficulties in gaining input from speech and language therapists. Staff and patients reported issues with staffing, leading to section 17 leave being cancelled. Patients provided mixed feedback about the food provided.
  • Observation windows with an external curtain and staff administering medication through the hatch of the clinic room did not promote privacy and dignity. Six patients also told us staff did not always knock before entering their bedrooms or looking through observation windows.
  • Feedback from patients and staff included some challenges in facilitating section 17 leave. It was unclear from the patient feedback whether this was due to patient expectations or because of agreed leave cancelation. However, records showed that only 14% of leave was cancelled due to staff shortages.

Community mental health services with learning disabilities or autism

Good

Updated 3 July 2018

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

  • The trust had acted upon our feedback from the previous inspection of this service. People’s risk assessments were available and easily accessible in all the electronic care records we reviewed. They were up to date and demonstrated staff assessed, managed, and monitored people to protect them from avoidable harm and abuse.
  • The teams we visited included a full range of staff disciplines. Staff worked in a collaborative manner and were flexible in their approach across the different functions provided in each location.
  • People received effective care and treatment. Staff planned and provided care and treatment that was in line with current evidence based standards and best practice. Staff completed care plans that were holistic, personalised, and involved people in decisions about their care and treatment.
  • There were sufficient numbers of skilled and experienced staff in the community teams. Staff felt their caseloads were manageable. All staff met the trust’s compliance target for appraisals, supervision and mandatory training. Staff we spoke with felt valued and well supported by their clinical leads.
  • Staff provided compassionate care and clearly understood people’s feelings, preferences and their social needs People were involved in decisions about their care and treatment. Communication with people was clear and individualised. Staff used open questions and simple language. They gave people time to respond and provided appropriate levels of verbal prompting if necessary.
  • The trust had acted upon our feedback from the previous inspection of this service. They had restructured the service to include multi-disciplinary teams providing a more joined up approach. This led to a significant reduction in waiting times with improved access to a range of specialist assessments. The community teams had a clear pathway that provided flexibility for staff to provide care that met the needs of individual patients. The intensive support teams responded to urgent and crisis referrals within the recommended referral wait times.
  • The service had a clear and effective leadership structure. Senior staff were knowledgeable about the service and committed to making continuous improvements. Staff morale was positive overall and the culture of the service was consistent with the trust values.

However

  • The base at Wakefield was in the city centre and also used by several mental health services. The location and multi-discipline use of the base presented staff with challenges regarding retention of health support workers and agile working. The waiting area was large and impersonal, with no easy read information displayed.

Long stay or rehabilitation mental health wards for working age adults

Good

Updated 24 February 2017

We rated South West Yorkshire Partnership NHS Foundation Trust as good because:

  • The service had effective governance process in place which demonstrated a clear link between senior management and front line staff.

  • Weekly multidisciplinary review meetings and risk review meetings were held and patients care plans and risk assessments were updated as required.

  • Patients had the opportunity to speak to a consultant at least once a month or more regularly if requested.

  • Patients’ physical health was monitored regularly through weekly physical health and wellbeing clinics led by a band 6 nurse and the junior doctor.

  • Staff had received training in the Mental Health Act and completed regular audits of patients consent to treatment records, all of which were correct and in date at the time of the inspection.

Community-based mental health services for older people

Good

Updated 8 February 2017

We rated South West Yorkshire Partnership NHS Foundation Trust as good because:

  • All the teams were using electronic patient records to store patient information. This meant staff had better access to records, the documentation and records were consistent, and there was less chance that work was duplicated or missed. Care documentation was completed in a timely manner.

  • Staff carried out routine assessments within the nationally recognised targets of 14 days, and urgent assessments within four hours. Teams were able to offer treatment to patients in a timely manner from assessment. All the teamsallocated a care coordinator within a week of the patient having their assessment. Some specialised treatments took longer than others, however, the trust data demonstrated they were able to meet all treatments within 18 weeks.Patients had access to crisis support 24 hours a day seven days a week.

  • At this inspection all the actions we told the provider it should take had been completed. Staff were learning from incidents at a local level, trust level and national level. Senior staff held monthly meetings open to all staff looking at serious incidents and what learning would take place. This included learning events where the trust reviewed incidents that took place in other services where the lessons learnt could also be applicable to them. Learning from incidents was also embedded into team meetings and supervision.

Community health services for children, young people and families

Good

Updated 24 June 2016

We rated community health services for children, young people and families as good because:

  • Services were safe and people were protected from harm. Staff knew how to manage and report incidents. We saw there had been learning following serious case reviews. Risks were actively monitored and acted upon. We found that there were good safeguarding processes in place.
  • We found that there was enough staff with the right qualifications to meet families’ needs.
  • The clinics and health centres we visited were clean.
  • Services were effective. We found good evidence that the service reviewed and implemented national good practice guidelines. The trust had also successfully implemented evidence based programmes, such as the family nurse partnership programme.
  • We also saw that patient outcomes and performance were monitored regularly, and that all staff received regular training, supervision and an annual appraisal. There was good evidence of multidisciplinary and multi-agency working across the services.
  • Services were caring. Children, young people and parents told us that they received compassionate care with excellent emotional support.
  • Services were responsive. We found the service planned and delivered services to meet the need of local families. Parents, children and young people were able to quickly access care at home or in a location that was appropriate to them.

  • Services were well led. Staff we spoke with told us the patient was at the centre of what they do, they were positive and proud about working for the organisation. There was an open culture in the service, and staff were engaged in the process of service improvement. Staff reported being supported by their line managers and teams within the organisation.
  • Staff worked with national and regional partners to share good practice. The service had been recognised by the Department of Health for their information sharing procedures and also received recognition from the Institute of Health Visiting and NHS England following the development of the health visitor caseload weighting tool. All managers were very proud of their teams.

Community health services for adults

Good

Updated 24 June 2016

We rated this core service as good because:

  • Systems to manage and report incidents were in place, safeguarding procedures were robust and records were up to date.
  • Medicines were stored and administered appropriately. Equipment was readily available and cleanliness and infection control procedures were followed.
  • Risks to the delivery of care for patients were managed and action taken to mitigate them.
  • Services were mainly fully staffed, mandatory training was up to date and staff development was supported.
  • Care and treatment followed evidence based guidance.
  • Care pathways were coordinated, multidisciplinary working was effective and outcomes for patients were evidenced and audited.
  • Patient’s consent to care and treatment was documented.
  • Care was delivered with compassion and staff treated patients with dignity and respect. Patients were involved in decisions about their care and treatment and received emotional support.
  • Community services had a clear vision focussed on the patient at the centre and the needs of patients influenced the planning and delivery of services, including care for patients with diverse cultural needs.
  • Patients had timely access to services, with minimal waits for most services. Few complaints were received by the service.
  • Governance arrangements supported the delivery of care for patients. Performance measures were used which were monitored and action was taken when issues were identified.
  • The service demonstrated a positive, focussed culture.
  • Community services operated in an environment that encouraged improvement and innovation.

Community health inpatient services

Good

Updated 24 June 2016

We rated community inpatient services as good because:

  • The service prioritised patient protection and there were defined systems, processes and standard operating procedures to keep people safe and safeguarded from abuse. We saw evidence of open and transparent culture in relation to incident reporting. Opportunities were available to learn from investigations and staff were comfortable reporting their concerns or any near misses. The duty of candour process and practice was in place across all community inpatient locations. Complaint and concern responses were provided in a timely way with improvements made to the quality of care as a result.

  • The department was clean and there were infection control and prevention audits, which showed high scoring outcomes. We found that medicine management and recording of information was to a good standard and well maintained.

  • Training levels were in line with trust targets as a whole and staff competence was apparent during inspection. All safeguarding training took place as part of the trust’s mandatory training programme and nursing staff demonstrated a good level of knowledge in relation to safeguarding triggers, forms of abuse and processes.

  • Risks to people who use services were assessed, monitored and managed on a day-to-day basis. Risk assessments were person-centred, proportionate and reviewed regularly. The service applied national early warning scores to identify when the escalation of care needs was appropriate.

  • Feedback from numerous patients across both of the community locations was very positive. We heard that staff responded compassionately to patients’ needs and were skilled in dealing with vulnerable individuals with complex physical and mental health needs. Relatives said they felt involved and had the opportunity to speak with medical and nursing staff when required.

  • We observed the treatment of patients to be compassionate, dignified, and respectful throughout our inspection. Ward managers were available on the wards so that relatives and patients could speak with them as necessary. Staff were hard working, caring and committed to delivering a good quality service. They spoke with passion about their work and were proud of what they did.
  • We found that the trust’s contribution to local and national audit was in line with the national average, and evidence of changes made by specialities in response to their outcomes was available and had been actioned.
  • Planning and delivery processes were in a place to enable services to meet the needs of the local population. The importance of flexibility, choice and continuity of care was evident within each service. The needs of different people were taken into account when planning and delivering services and reasonable adjustments were made to remove barriers when people found it hard to use or access services.

  • There was evidence of competent, responsive, multidisciplinary working between all professionals. They worked closely with the local authority when planning discharge of complex patients and when raising safeguarding alerts.

  • The behaviours and actions of staff working in the division mirrored the trust values of ‘patients’ first, safe and high quality care, and responsibility and accountability’ of which we saw multiple examples of during our inspection.

End of life care

Good

Updated 24 June 2016

Overall we rated the trust as good for community end of life care services because:

  • Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. Lessons were learned and communicated widely to support improvements.

  • High performance within the service was recognised by credible external bodies.

  • Staff in the community and on the wards of the community hospitals demonstrated a consistently good level of knowledge of end of life care issues.

  • The palliative care team was multi-disciplinary with medical, nursing, social work, occupational therapy, physiotherapy and dietetic membership.

  • The end of life care lead for the trust was also the end of life care lead for the locality and the trust had a significant role in contributing to the shaping of end of life care services.

  • We saw that staff would find ways of making the experience of care as easy as possible for people and that there was a commitment to end of life care at all levels ofthe community service.

  • 84% of patients known to the Specialist Palliative Care Team achieved their preferred place of care at the end of life.

  • The integrated multidisciplinary model adopted by the palliative care service supported the development of responsive care packages in the community, including the management of a supportive care at home service.

  • There was a clear vision, strategy and values for end of life care with well-defined objectives that were reviewed as part of a district end of life care steering group.

  • We observed strong leadership from the Specialist Palliative Care Team (SPCT) and senior staff in the community.

  • There was a commitment and culture for providing high quality end of life care that was patient focused.

  • Innovation was apparent across the SPCT as a whole.

  • The service proactively engaged staff and patients to ensure their views were heard and acted upon, including the use of volunteers to obtain patient and family feedback.