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Provider: Birmingham and Solihull Mental Health NHS Foundation Trust Requires improvement

Read our previous full service inspection reports for Birmingham and Solihull Mental Health NHS Foundation Trust, published on 9 September 2014.

Inspection Summary


Overall summary & rating

Requires improvement

Updated 5 April 2019

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

  • The trust had made insufficient improvements since our last comprehensive inspection in March 2017. This is reflected in the ratings of the core services that we inspected at this most recent inspection. The ratings for two of these five core services have changed from good to requires improvement. This means that four of the trust’s nine core services are now rated as requires improvement overall. We have also once again rated the safe and effective key questions as requires improvement for the trust overall.
  • There were continued concerns raised by some staff from diverse backgrounds about the support they received and whether they were listened to. This was shown in the staff survey results from 2017.
  • Many of the wards that we visited during this inspection had a shortage of permanent nursing staff. They relied heavily on agency and bank staff. This had an impact on the quality of patient care; including the adequacy of risk assessments of patients.
  • Staff consistently told us about a lack of consultation when the trust implemented a new model of working on acute mental health wards. The model integrated occupational therapists into the nursing teams on these wards. As a result, both disciplines could not carry out their basic duties. For example, occupational therapists had less time to carry out therapeutic activities with patients and there were delays in patients receiving medicines from nurses. This had an impact on the morale of staff.
  • Managers did not ensure staff received appropriate professional support and supervision to carry out their duties effectively. Staff had difficulty accessing clinical supervision and there were problems in how managerial supervision was recorded.
  • Some wards did not have fixed nurse call buttons in patients' bedrooms. Staff did not mitigate the risk this posed by assessing whether individual patients, who might be at risk or otherwise be vulnerable, should be provided with a portable alarm to request assistance if needed.

  • Care plans were not always personalised, holistic or updated.
  • Feedback from carers was not always positive regarding staff engagement and a response from concerns.
  • Patients could not always access a mental health bed in a timely manner when in crisis. There were blocks in the wider health and social care system in accessing mental health assessments for patients in crisis.
  • There continued to be problems with medicines management across the trust. Staff did not always follow best practice when storing, dispensing, and recording medication. Staff did not regularly review the effects of medications on each patient’s physical health following the use of rapid tranquilisation.

However:

  • The trust had improved the board assurance framework and risk register. It was now robust and clear. The trust leadership team had improved its cohesion. A plan for quality improvement to improve patient care and safety had started but required further work to embed across the trust. The trust leadership team had the necessary skills and experience to provide innovation and change. The trust had a good understanding of the wider health and social care economy, and were active in shaping local transformation plans.
  • The trust had improved the way it searched patients across services. There was improved individual risk assessments of patients and staff rather than a blanket restriction for search. The trust has also removed blanket restrictions relating to takeaway food providers
  • The trust had improved staff knowledge and application of the Mental Capacity Act across its services. Staff understood their roles and responsibilities under the Mental Health Act 1983 and the Mental Health Act Code of Practice and discharged these well. Managers made sure that staff could explain patients’ rights to them.
  • Staff treated patients with compassion and kindness. They almost always respected patients’ privacy and dignity, and supported their individual needs.

Inspection areas

Safe

Requires improvement

Updated 5 April 2019

Our rating of safe stayed the same. We took into account the previous ratings of services not inspected at this time. We rated it as requires improvement because:

  • There were insufficient permanent registered nursing staff to meet the needs of patients. There was high use of bank and agency staff. We found that patients had to wait for treatment and activities. There was variation in the frequency and quality of risk assessments across the service.
  • Medicines management across trust services remained a problem. Staff did not always follow best practice when storing, dispensing, and recording medication. There were many recorded errors in practice. Staff did not carry out physical health checks consistently after administering rapid tranquilisation. Staff did not always record a discussion of the side effects of valproic acid/valproate with female patients to whom it had been prescribed.
  • Not all staff felt safe across its services. Staff did not always have access to an alarm system or personal alarms to alert others in the case of an emergency.
  • The Building Note relating to acute mental health wards states that 'Service user to staff system call points should be provided in spaces where a service user or attendee may be left alone temporarily, for example within service user bedrooms, en-suite WCs, disabled WCs and therapy or education areas'. Some wards did not have fixed nurse call buttons in patients' bedrooms. Staff did not mitigate the risk this posed by assessing whether individual patients, who might be at risk or otherwise be vulnerable, should be provided with a portable alarm to request assistance if needed.

However:

  • The board, senior leaders and clinical staff had a shared understanding of the main risks to the trust.
  • Since the previous inspection in March 2017, the trust had reviewed it policy and processes when searching patients. The trust had introduced systems that meant blanket restrictions in searching individual patients did not occur.
  • Although figures for prone restraint were similar to the previous inspection in 2017, they were lower than comparable trusts. The use of restrictive interventions, such as restraint, was well managed and reviewed across trust services. Staff participated in the trust restrictive interventions reduction programme. Staff recognised incidents and knew when to report them.
  • Staff understood how to protect patients from abuse and the trust worked well with external organisations when Reporting safeguard incidents.
  • Wards and the team bases for community services were clean, well equipped, furnished and well maintained. There were environmental risk assessments in place and patients were kept safe. Staff followed infection control practice evident across all services.

Effective

Requires improvement

Updated 5 April 2019

Our rating of effective stayed the same. We took into account the previous ratings of services not inspected at this time. We rated it as requires improvement because:

  • Care plans across the trust were not always personalised, holistic or involved the patient. This is what we also found at the previous inspection in March 2017. They did not always meet the needs of the patient and were not always reviewed or updated in line with trust guidance.
  • Staff did not have access to regular managerial and clinical supervision. The recording and reporting system for management and supervision and clinical supervision required improvement. Appraisal rates in some services did not meet the trust target. This meant that staff did not have the necessary time to reflect on their practice and career development.
  • Following the introduction of a new model of working in mental health acute wards, staff raised concerns about the integration of occupational therapists into the ward staffing complement. This meant that occupational therapists had reduced capacity to effectively carry out their roles including undertaking activities with patients.
  • Section 62 Mental Health Act paperwork was not always reviewed and referrals for a second opinion appointed doctor were not always completed on time.

However:

  • Staff across the trust had improved their knowledge and skills in the Mental Capacity Act and Gillick competence since the previous inspection in March 2017. Most services were compliant with the Mental Health Act and the Code of Practice. Patients’ were read their rights when detained and were regularly updated.
  • Physical health monitoring for patients with mental health problems was co-ordinated well across the trust. Patients were regularly reviewed by multidisciplinary teams and they were supported to live healthier lives. Care and treatment interventions were aligned to national best practice and guidance, and staff participated in regular audit.
  • Staff had access to induction and training that supported their roles. Compliance across the trust was above 75% and regularly achieved the trust target of 90%.

Caring

Good

Updated 5 April 2019

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

  • Staff treated patients with compassion and kindness. Staff were caring and passionate about their roles. They respected patients and worked hard to ensure patients’ needs came first. Staff ensured that patients had easy access to independent advocates.
  • Staff across most services involved patients in care planning and risk assessments but this was not always reflected in the electronic healthcare records.
  • The trust had embedded the ‘See Me’ programme and had improved patient involvement in planning trust services.

However:

  • Staff had not ensured the confidentiality of confidential information in one older people’s mental health ward.

Responsive

Good

Updated 5 April 2019

Our rating of responsive stayed the same. We took into account the previous ratings of services not inspected at this time. We rated it as good because:

  • The design, layout, and furnishings of the wards and most services supported patients’ treatment, privacy and dignity. Patients had their own rooms where they could keep personal belongings safe. There were quiet areas for privacy and where patients could be independent of staff when risk allowed.
  • Staff supported patients with activities outside the service, such as work, education and family relationships. This included access to the recovery college that was valued by patients. The service was accessible to all who needed it and took account of patients’ individual needs. Staff helped patients with communication, advocacy and cultural support. The trust worked positively with ethnically diverse communities.
  • The service treated concerns and complaints seriously, investigated them and learned lessons from the results, and shared these with all staff.

However:

  • When there was high demand for crisis services and beds in acute mental health awards, the trust could not always meet the needs of patients. There were delays in mental health assessments for people in the emergency departments at local acute hospitals and in health-based places of safety because of a lack of access to approved mental health professionals. Some patients in the PDU were on occasion waiting over 24 hours for treatment. Bed occupancy rates in adult mental health wards were regularly over 100% and patients did not always have a bed to return to following leave. There was not always a bed available when patients required a psychiatric intensive care bed.

Well-led

Requires improvement

Updated 5 April 2019

Our comprehensive inspections of NHS trusts have shown a strong link between the quality of overall management of a trust and the quality of its services. For that reason, we look at the quality of leadership at every level. We also look at how well a trust manages the governance of its services – in other words, how well leaders continually improve the quality of services and safeguard high standards of care by creating an environment for excellence in clinical care to flourish.

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

  • The trust had made insufficient improvements since our last comprehensive inspection in March 2017. This is reflected in the ratings of the core services that we inspected at this most recent inspection. The ratings for two of these five core services have changed from good to requires improvement. We have also once again rated safe and effective as requires improvement for the trust overall.
  • There were local governance issues in some core services linked to the quality of care plans, medicines management and risk assessments.
  • There was a shortage of staff across key clinical services and a reliance on bank and agency staff. There were not effective systems in place for staff to receive supervision and for managers to collect the information. This impacted on the morale of staff.
  • We heard from staff about bullying and discrimination within parts of the organisation. This appeared to be a cultural problem that had existed for a number of years. We recognised that the trust was working hard to address these issues but further work was required.

However:

  • In the months preceding this inspection, the trust had improved collective leadership and the board and senior leaders were confident about plans to improve the quality of care. The trust was working with a number of organisations and stakeholders to improve services. They had learnt from other organisations to develop a culture of quality improvement and we saw signs of achievement.
  • The board and senior leadership team had set a clear vision and values that were at the heart of all the work within the organisation. Clinical managers we spoke to shared the same values and the majority thought that the trust was well-led. Senior leaders were visible and well connected with services. They had a shared understanding with clinical staff of the risks the trust face.
  • The trust had improved the skills and knowledge of staff in the Mental Capacity Act since the previous inspection in March 2017. Safeguarding structures and processes are clearly defined and were working effectively.
  • The trust was working positively with a range of partners in the wider health and social care economy. This ranged from influencing local sustainability and transformation plans, working with three NHS trusts locally as part of an innovative MERIT Vanguard, and within an accountable care organisation with one other NHS trust and independent healthcare charity to commission and deliver secure care services.
  • The trust had developed and was working positively with patient and carer groups. The ‘See Me’ service user involvement scheme was valued by patients and carers. The trust ran a number of groups and courses for patients and carers in local communities, often reflecting the diverse communities it served, that included the recovery college and mindfulness awareness.
  • The trust was committed to improve services by promoting research, innovation and training. There was strong links with universities that underpinned collaborative working around workforce and clinical practice. Staff were encouraged to work on ideas to improve practice and leadership courses were available for staff to attend.
  • The trust collected, analysed, managed and used information well to support its activities, using secure electronic systems with security safeguards. The trust treated concerns and complaints seriously, investigated them and learned lessons from the results, and shared these with all staff.

Checks on specific services

Forensic inpatient or secure wards

Requires improvement

Updated 5 April 2019

We rated this service as requires improvement because:

  • All patients had risk assessments and care plans in place but they were not consistently of a good quality. At the Tamarind Centre and Reaside Hospital we saw examples of risk assessments that were incomplete or did not have up to date information. The information contained within some care plans was not personalised and specific to the individual.
  • Staff at the Tamarind Centre and Reaside Hospital used the electronic recording system in such a way that it could be difficult for new starters or bank and agency staff to find the information they were looking for.
  • The service did not minimise the use of restrictive practices on all wards. We found blanket restriction in place at The Tamarind Centre relating to choice at mealtimes.
  • Staff supervision levels on some wards at the Tamarind Centre and Ardenleigh were below 75% due to staff shortages over the twelve months prior to our inspection though there were action plans in place to address this.

However:

  • 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 managed medicines safely and followed good practice with respect to safeguarding.

  • 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 specialists required to meet the needs of patients on the wards. 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.

  • Staff planned and managed discharge well and liaised well with services that would provide aftercare. As a result, discharge was rarely delayed for other than a clinical reason

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

Requires improvement

Updated 5 April 2019

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

  • Staff did not always follow National Institute of Health and Care Excellence and trust guidance following rapid tranquilisation and seclusion reviews. Records showed gaps in monitoring patients’ physical health following administration of intra muscular medicines for rapid tranquilisation and in the records of the reviews required for secluded patients in line with the Mental Health Act, Code of Practice and the trusts policy.
  • Staff did not always record the fact that that they had undertaken a discussion with females of childbearing age regarding the risk of valproate medicines.
  • Most wards had a high number of vacancies and high use of agency and bank staff. This led to some shifts being unfilled. This placed increased pressure on staff and also impacted upon their ability to access supervision. The staffing model did not always ensure an appropriate skill mix was in place on wards to provide safe and effective care and treatment.
  • Despite the trust implementing a smoke free environment in April 2017, some staff at Mary Seacole House continued to tolerate smoking within the ward gardens on wards 1 and 2. This meant patients had access to cigarette lighters on the wards, which they concealed from staff. This may put themselves or others at risk. Staff at other locations enforced the no smoking policy offering suitable alternatives to the patients.
  • Staff did not always write holistic, personalised or recovery focussed care plans and did not always record if they had offered patients a copy of their care plan.
  • Staff did not always have the appropriate Mental Health Act paperwork to authorise administration of medicines. We found that section 62 paperwork was not always reviewed and staff were sometimes unable to tell us if a referral to a second opinion approved doctor had been made. We had found that this was an issue for some wards during the 2017 core service inspection.
  • The service experienced bed pressures. Most wards had bed occupancy rates above 100%. Beds were not always available to patients on return from leave.
  • Our findings from the other key questions demonstrated that governance processes did not always operate effectively at ward level. There were variations across sites and amongst wards. This had led to lapses in medicines management, observations following rapid tranquilization and seclusion reviews, issues with staffing levels and skill mix, lapses in implementing the non-smoking policy and supervision rates were poor.

  • The Building Note relating to acute mental health wards states that 'Service user to staff system call points should be provided in spaces where a service user or attendee may be left alone temporarily, for example within service user bedrooms, en-suite WCs, disabled WCs and therapy or education areas'. These wards did not have fixed nurse call buttons in patients' bedrooms. Staff did not mitigate the risk this posed by assessing whether individual patients, who might be at risk or otherwise be vulnerable, should be provided with a portable alarm to request assistance if needed.

  • Although staff supported each other, morale was poor and they felt under pressure. Some staff told us that they did not feel heard or listened to by senior management within the trust.

However:

  • The trust had implemented six out of the seven actions we told them they must make to improve since the last inspection in March 2017. Staff engaged actively in local and national quality improvement activities. Staff knew and understood the provider’s vision and values and how they were applied in the work of their team.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity and understood the individual needs of patients. They actively involved patients and families and carers in care decisions.
  • The ward environments were safe and clean. Staff minimised the use of restrictive practices, completed a risk assessed in a timely manner and staff assessed the physical and mental health of all patients on admission.
  • Staff understood how to protect patients from abuse and/or exploitation and the service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and/or exploitation and they knew how to apply it.

  • The wards had a good track record on safety. The service managed patient safety incidents well. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team and the wider service. When things went wrong, staff demonstrated duty of candour; staff apologised and gave patients honest information and suitable support.

Child and adolescent mental health wards

Good

Updated 5 April 2019

We rated this service 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 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 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 understood and discharged their roles and responsibilities under the Mental Health Act 1983 and the Mental Capacity Act 2005. They followed good practice with respect to young people’s competency and capacity to consent to or refuse treatment.
  • Staff treated patients with compassion and kindness, respected their privacy and dignity and understood the individual needs of patients. They actively involved patients and families and carers in care decisions.
  • Staff planned and managed discharge well and liaised well with services that would provide aftercare. As a result, discharge was rarely delayed for other than a clinical reason.
  • The service was well led and the governance processes ensured that ward procedures ran smoothly.

Mental health crisis services and health-based places of safety

Updated 5 April 2019

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

  • The services did not have enough staff to keep people safe from avoidable harm. The number of patients on the caseload of the mental health crisis teams was high.
  • Staff did not always follow trust guidelines in relation to medicines management.
  • Staff did not always respond in a timely manner when patients contacted the service and at times had to wait to be seen by staff.
  • Governance processes did not operate effectively. The systems and processes did not always support staff to carry out their roles, for example managers did not ensure that staff had regular supervision and annual appraisals. Staff said morale was low.

  • The mental health crisis teams did not always have access to the full range of specialists required to meet the needs of the patients. Senior management were aware of this and a business case had been developed to address this issue.

However:

  • Staff working for the mental health crisis teams developed holistic, recovery-oriented care plans informed by a comprehensive assessment. They provided a range of treatments suitable to the needs of the patients.

  • Staff worked well together as a multi-disciplinary team and with relevant services outside the organisation.
  • Clinical premises where patients were seen were safe and clean and the physical environment of the health-based places of safety met the requirements of the Mental Health Act Code of Practice.

  • 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 and understood the individual needs of patients. They actively involved patients, families, and carers in care decisions.

Wards for older people with mental health problems

Requires improvement

Updated 5 April 2019

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

  • Staff had not updated environmental risk assessments appropriately on Ashcroft Ward and Reservoir Court. This meant that staff working on the wards were not working within the most up to date document and may not identify accurately where potential risks such as ligatures were and how these should be managed to keep patients safe. Staff on Ashcroft Ward did not always have access to personal alarms and reported that they could not be heard in all areas of the ward when activated which added to the potential risk for patients.
  • Staff on Ashcroft Ward did not always follow best practice when storing, dispensing, and recording the use of medicines. For example, we found medication was not always stored at the correct temperature and staff did not record how this was managed. Staff could not be sure that medication was safe to administer to patients.
  • The trust had high use of agency and bank use across all wards. There had been delays in accessing a medic quickly on Reservoir Court. Staff we spoke with had concerns about the impact on patient care.
  • On Ashcroft Ward we found that not all patient information was stored appropriately in locked storage. This meant that people other than staff could access a patient’s information without their consent.
  • Feedback from carers was not always positive regarding staff engagement and response to concerns raised at ward level. Carer involvement was not routinely recorded in care records.

However:

  • The ward environments were safe and clean. Staff assessed and managed risk well on most wards. They minimised the use of restrictive practices, and followed good practice with respect to safeguarding.
  • Staff developed 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 and 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 specialists required to meet the needs of patients on the wards. Managers ensured that these staff received training and appraisal. The ward staff worked well together as a multidisciplinary team and with external agencies 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.
  • Managers followed governance process set out by the trust that ensured the wards ran smoothly. Staff had a clear framework for sharing information from ward to executive team level.

Specialist community mental health services for children and young people

Good

Updated 8 March 2018

We changed the overall rating of inadequate to good because:

  • On inspection we found that the trust had put systems and processes in place to address the actions we had told them they ‘must’ take to address regulatory breaches we had found on inspection in March 2017. The trust had also taken action to address the ‘shoulds’ we recommended they take to improve the service.

  • Staff completed risk assessments for children and young people. These were recorded in the care records and updated every six months or as needed.

  • Staff routinely established and recorded consent to treatment and documented evidence of considering Gillick competence and capacity where appropriate.

  • Senior management had reviewed policies and procedures relating to the running of the service. These policies had been agreed by the trust and review dates for 2020 had been set.

  • Staff ensured that prescription pads and prescriptions were stored in line with the trust policy.

  • Staff monitored the cleanliness and working order of physical health monitoring equipment and therapeutic toys.

  • Staffing vacancies had reduced and the service had 15 more whole time equivalent staff than on our previous inspection March 2017. Turnover had reduced from 25% to 13%.

  • Staff compliance with mandatory training, supervision and appraisals was good and compliance rates above the trust target level of 90%.

  • Work was in progress to make both sites more child and young person friendly and to increase the level of sound proofing within interview rooms.

However:

  • The mobile phone staff safety application was not fully working or accessible on 50% of staff mobile phones.

  • Staff were using trust templates on the electronic care record system to record care plans. However, we felt that there was further improvement required. Not all care plans were detailed, personalised and holistic. We found evidence of basic care planning in 15 of the 28 care records we reviewed. The majority of these basic care plans were found within the eating disorders team. Care plans did not always record or reflect the voice of the patient, or reflect the quality of care staff were providing.

  •   The service did not undertake regular audits of care records to assure progress in this area.
  • We were not assured that staff reported all incidents on the trust incident recording system or aware of what they should report. We were told of two incidents that should have been reported and had not been reported.

Community-based mental health services for adults of working age

Good

Updated 2 August 2017

We rated community based mental health services for adults of working age as good because:

  • All locations where patients were seen and treated had access to emergency equipment.

  • All buildings were clean and well maintained.

  • There was adequate hand washing facilities and we observed staff following infection control practices.

  • Patients and carers were happy with the way that staff worked and the services that were offered to them.

  • Patients felt that their needs were met and that the services belonged to their community.

  • Staff felt supported by senior managers and told us that they were able to share their concerns with the chief executive officer for the trust.

Community-based mental health services for older people

Good

Updated 1 August 2017

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

  • Staff routinely completed and updated patient risk assessments. They developed and recorded crisis plans with patients. This meant there were plans in place to reduce risks if patients were in crisis. Staff had a good understanding of safeguarding and the procedures to keep people safe from abuse. The service carried out regular environmental risk assessments to monitor and improve the safety of buildings.

  • The service had clear policies to support staff when they worked alone. Staff were aware of the lone working policy and the procedures to follow if they needed support when working alone. Staff knew how to report incidents and felt able to report concerns.

  • Staff knew their patients well. They kept records of patient care and treatment up-to-date, including any changes in circumstances. Staff routinely carried out mental capacity assessments when necessary and supported patients to manage their physical health needs.

  • The service worked well with other teams and agencies to enable patients to move between services as their needs changed. Staff communicated promptly and effectively with patients’ GPs and other relevant agencies.

  • Staff treated patients with kindness, dignity and respect. They routinely involved patients and carers in developing their assessments and care plans. The service was responsive to the needs of patients, carers and care homes. Patients told us they could get appointments when they needed them and doctors were accessible to both staff and patients. They said they could contact their allocated worker if they needed to speak with them. Patients were very positive about the service they received. The trust employed a team to gather feedback from patients and carers and used the information to make improvements to the service.

  • Staff had access to regular supervision and there were some opportunities for them to develop their skills and career. They were up-to-date with their mandatory training. Staff had a working knowledge of the Mental Health Act and the Mental Capacity Act.

  • Local leaders were visible and accessible to staff. Senior managers sometimes visited the teams.

  • Managers carried out regular audits, including audits of patient records. The service recorded referral and discharge data. They used dashboards to inform staff and managers if they were meeting their key performance indicator targets. This meant they could tell how long people waited to be seen by the teams and if staff carried out reviews in a timely manner.

However:

  • The service did not have a consistent process to audit safe and secure handling of medicines within the community teams. The trust pharmacy team carried out audits at each site in early 2017 but prior to this, there were gaps of over three years in some teams. There was no effective monitoring of clinic room temperatures in three teams and the clinic rooms in two teams were dusty and cluttered. Staff in most teams told us they believed their caseloads were too high and many told us they felt they needed to work at home, in their own time, to perform essential activities such as updating care plans and risk assessments.

  • Caseloads were high and some staff worked unpaid hours to complete essential case recording.

  • In some areas of the service, staff told us there were long waiting times for patients to access psychological therapies. The trust told us the longest waiting time was four weeks.

  • Most carers and patients did not know how to make a complaint about the service. Despite this, they told us they were sure they could find out how make a complaint if they needed to and were confident they would be listened to.

  • Consulting rooms where staff saw patients at the East Hub were very poorly soundproofed which meant conversations could be easily overheard. Consulting rooms at the North Hub had glass panels, which meant people using the corridor, could easily look in.

  • Some staff felt senior managers did not listen to the feedback they provided about organisational change and they had not received a response when they had used the trust formal feedback process called “Dear John”. Three staff said they did not have confidence in the whistleblowing process or in the Dear John process.

  • A number of staff felt unsettled about the organisational changes taking place within the trust and this led to a degree of low morale within most teams.

Long stay or rehabilitation mental health wards for working age adults

Good

Updated 1 August 2017

We rated the Long stay rehabilitation mental health wards as good because:

  • We found the units to be clean, spacious and comfortable with good quality furnishings and décor throughout, including well-maintained gardens.
  • Staff interactions with patients were appropriate and demonstrated a good understanding of individual patient needs.
  • Patients had the choice of a wide range of therapeutic interventions and activities to aid rehabilitation.
  • Carers were involved in the care of their relatives. We saw resources for carers and information on carers groups. Each unit had a carers champion /lead.

However;

  • Medicines management practices were inconsistent and potentially put patients at risk. We found discrepancies relating to the storage, prescribing and administration of medicines.