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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.

Reports


Inspection carried out on 5/11/2018

During a routine inspection

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.


CQC inspections of services

Service reports published 5 April 2019
Inspection carried out on 5/11/2018 During an inspection of Forensic inpatient or secure wards Download report PDF | 439.81 KB (opens in a new tab)Download report PDF | 2.16 MB (opens in a new tab)
Inspection carried out on 5/11/2018 During an inspection of Acute wards for adults of working age and psychiatric intensive care units Download report PDF | 439.81 KB (opens in a new tab)Download report PDF | 2.16 MB (opens in a new tab)
Inspection carried out on 5/11/2018 During an inspection of Child and adolescent mental health wards Download report PDF | 439.81 KB (opens in a new tab)Download report PDF | 2.16 MB (opens in a new tab)
Inspection carried out on 5/11/2018 During an inspection of Mental health crisis services and health-based places of safety Download report PDF | 439.81 KB (opens in a new tab)Download report PDF | 2.16 MB (opens in a new tab)
Inspection carried out on 5/11/2018 During an inspection of Wards for older people with mental health problems Download report PDF | 439.81 KB (opens in a new tab)Download report PDF | 2.16 MB (opens in a new tab)
See more service reports published 5 April 2019
Service reports published 15 November 2018
Inspection carried out on 6 September 2018 During an inspection of Acute wards for adults of working age and psychiatric intensive care units Download report PDF | 216.73 KB (opens in a new tab)
Service reports published 8 March 2018
Inspection carried out on 3 - 5 January 2018 During an inspection of Specialist community mental health services for children and young people Download report PDF | 291.2 KB (opens in a new tab)
Service reports published 2 August 2017
Inspection carried out on 27 March – 31 March 2017 During an inspection of Community-based mental health services for adults of working age Download report PDF | 293.97 KB (opens in a new tab)
Service reports published 1 August 2017
Inspection carried out on 28-30 March 2017 During an inspection of Wards for older people with mental health problems Download report PDF | 324.61 KB (opens in a new tab)
Inspection carried out on 27 – 31 March 2017 During an inspection of Child and adolescent mental health wards Download report PDF | 378.22 KB (opens in a new tab)
Inspection carried out on 27-31 March 2017 During an inspection of Acute wards for adults of working age and psychiatric intensive care units Download report PDF | 356.13 KB (opens in a new tab)
Inspection carried out on 27-31 March 2017 During an inspection of Community-based mental health services for older people Download report PDF | 356.46 KB (opens in a new tab)
Inspection carried out on 27-31 March 2017 During an inspection of Specialist community mental health services for children and young people Download report PDF | 370.58 KB (opens in a new tab)
Inspection carried out on 27 March – 31 March 2017 During an inspection of Long stay or rehabilitation mental health wards for working age adults Download report PDF | 325.01 KB (opens in a new tab)
Inspection carried out on 27- 31 March 2017 During an inspection of Forensic inpatient or secure wards Download report PDF | 344.44 KB (opens in a new tab)
Inspection carried out on 27th-30th March 2017 During an inspection of Mental health crisis services and health-based places of safety Download report PDF | 464.59 KB (opens in a new tab)
See more service reports published 1 August 2017
Service reports published 12 September 2016
Inspection carried out on 25 May 2016 During an inspection of Forensic inpatient or secure wards Download report PDF | 232.19 KB (opens in a new tab)
Inspection carried out on 27-31 March 2017

During a routine inspection

Following the inspection in March 2017, we have changed the overall rating for Birmingham and Solihull Mental Health NHS Trust from Good to Requires Improvement because:

  • Feedback from staff and evidence from the most recent NHS staff survey suggested a disjoint between the board and staff at service level. Staff groups in several areas reported feeling under-valued and as being unheard concerning key decisions and service re-design.
  • The trust had taken a blanket approach to searches and ordering of food from take away restaurants. The decisions made at board level in relation to the restrictions did not take account of individual risk assessment or patient choice.
  • The oversight and safety of medicines management was compromised as the trust did not have a medicines safety officer in post. The trust policy concerning rapid tranquilisation was also out of date and did not reflect updated guidance from the national institute of health and care excellence.
  • Staff knowledge, understanding and application of the Mental Capacity Act was poor in those community services that cared for children and young people and in the wards for older people with mental health problems.
  • We found that the trust processes for assuring their contractual obligations concerning equality and diversity lacked robustness. In some teams, the provision of information for Non-English speakers was insufficient and in contravention with the Equality Act 2010.
  • The Board Assurance Framework did not focus on strategic risks and instead was an extension of the corporate risk register. This meant that the board were unable to provide robust evidence of an understanding of the trusts corporate risks.

However:

  • Staff, throughout the organisation, were caring, compassionate, kind and treated patients with dignity and respect. Feedback from patients and carers was positive and highlighted the staff as a caring group.
  • Staffing levels across the trust were generally safe and sufficient to provide good care.
  • The trust was involved in several vanguards and new models of care partnerships with external partners. Overall, external bodies were positive about the trust and its role in addressing the challenges faced by the local health economy.
  • Trust services were responsive to the needs of the patient group; this was evident in the inpatient and community services that we visited.

Inspection carried out on 12- 15 May 2014

During a routine inspection

Birmingham and Solihull Mental Health NHS Foundation Trust provides mental health services in Birmingham and Solihull to over a million adults aged 18 years and older. It does not provide any children’s mental health services.

We found that the trust was providing a good service overall to the population that it served. Within the core services inspected, we saw evidence of innovative and good practice. This was being delivered by caring and professional staff who were working together.

Improvements were required by the trust to ensure that the safety concerns identified in some of the core services inspected were addressed. We saw robust systems in place for managing most of the risks within the trust. There were clear trust protocols for identifying and investigating safeguarding concerns. Most staff were aware of their role in proactively identifying and reporting risks.  

Overall the trust provided an effective service. We found that it provided evidence-based treatments that were in line with best practice guidelines. People were supported to make choices and, where possible, gave informed consent. Evidence that effective outcome measures were being used. The trust employed appropriately qualified and trained staff. On some of the units we visited, records of when people were detained for treatment under the Mental Health Act 1983 were inconsistently completed.

Overall the trust provided a caring service. We saw examples of staff treating people with kindness dignity and compassion. Feedback from people and their visitors was generally positive about their experiences of the care and treatment provided by the trust. Individual concerns about care being provided to some people were brought this to the attention of senior staff who responded appropriately.

Overall the trust provided a responsive service. We noted that the trust organised services to meet the needs of people in the local area. People’s individual needs and wishes were met when their care and treatment was being assessed, planned and delivered. There was an emphasis on avoiding unnecessary admissions wherever possible.

We concluded that the trust was well-led, with proactive and responsive trust-wide leadership. Staff felt engaged and were well supported by their local managers. There were clear clinical governance systems in place to monitor and improve the trust’s performance.

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.


Organisation Review of Compliance


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.