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Provider: Surrey and Borders Partnership NHS Foundation Trust Good

Read our previous full service inspection reports for Surrey and Borders Partnership NHS Foundation Trust, published on 24 October 2014.

Mental health service reports

We are carrying out checks on locations registered by this provider. We will publish the reports when our checks are complete.

Reports


Inspection carried out on 07 January to 12 February 2020

During a routine inspection

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

  • Staff in the trust had worked hard to maintain the improvements that we found in our last inspection. The four core services that we inspected maintained their rating of good which means that all ten of the trust’s core services have a rating of good.
  • During this inspection we inspected four core services and carried out a well-led review. In rating the trust we have taken into account the previous ratings of the six mental health services not inspected this time.
  • We found that the trust was led by a highly skilled and experienced senior team, including the chair and non-executive directors. There was a strong patient-focussed, learning culture within the trust and staff showed caring, compassionate attitudes, were passionate and proud to work for the trust and were involved in the development and improvements within the trust.
  • We found that the trust leaders had the skills, knowledge, integrity and experience to perform their roles and had a good understanding of the services they were delivering. Senior leaders were open and honest, presented and spoke with passion, compassion and authenticity.
  • There was a clear vision, underpinned by a set of values that were well understood by staff across the trust. The trust values were embedded in a real commitment to people, both staff and patients, and in creating a value-driven organisation.
  • Effective leadership from senior trust leaders and leaders in the community-based mental health services for working age adults was enabling staff to manage the separation of health and social care teams following the local authority taking back management of social care staff (this happened shortly before the inspection). The trust was supporting team leaders effectively and monitoring the impact on patients.
  • The trust had made improvements to the therapeutic programmes offered to patients within its inpatient wards since our last inspection. Both the variety of activities and their availability to patients across seven days per week had improved.
  • The trust was developing a digital strategy which supported the overall clinical strategy. This ensured that both strategies were aligned and focused on improving patient care and supporting staff to deliver care.
  • Generally, staff completed comprehensive risk assessments and managed risks well. Physical and mental health needs were assessed and monitored, and care plans were holistic and recovery orientated. Staff followed good practice with respect to safeguarding.
  • Patient safety incidents were managed well. Staff recognised incidents and reported them appropriately. Managers investigated incidents and shared lessons with their teams and the wider organisation.
  • Staff provided a range of care and treatment interventions suitable for the patient groups and these were consistent with national guidance on best practice.
  • Staff across all the services we inspected were kind, compassionate, supportive and respected the dignity of patients. Feedback from people using services and their relatives and carers was positive. Staff ensured that the emotional and spiritual needs of people who used services were addressed, along with their mental and physical healthcare needs.
  • Since the last inspection, the trust had appointed a Director of Workforce and was working to attract recruits to the organisation with a newly launched workforce strategy.
  • Staff across the trust were confident and willing to develop their services, using quality improvement methods. Staff were proud of the areas in which they worked. They felt encouraged and supported by the trust leaders to try out new ideas and improve the experience of people using their services.
  • The trust had positive and collaborative relationships with external partners and was actively engaged with the local health economy in shaping services, including patients, staff, equality groups and local organisations.

However

  • The wards at the Abraham Cowley Unit remained unfit for the purpose of delivering modern mental healthcare. The patient experience remained poor due to the dormitory accommodation, communal bathroom areas, drab and dreary environment experienced by most patients. The staff had worked hard and implemented many procedures to manage the overall environmental risks however, the physical design of the building and the wards meant that staff found it difficult to maintain patients’ dignity and privacy. We saw that the trust was continuing to consider options to replace the hospital and the board was moving forward with a longer-term plan. However current patient experience continued to be affected by the poor environment at the Abraham Cowley Unit.   
  • We noted that there were areas in governance and assurance that would benefit from a full review. The last formal governance review had taken place in 2016 and the trust informed us that they were working on commissioning such a review within the timescale set for NHS trusts.


CQC inspections of services

Service reports published 8 September 2020
Inspection carried out on 26 June 2020 During an inspection of Acute wards for adults of working age and psychiatric intensive care units Download report PDF (opens in a new tab)
Service reports published 1 May 2020
Inspection carried out on 07 January to 12 February 2020 During an inspection of Community-based mental health services for adults of working age Download report PDF (opens in a new tab)Download report PDF (opens in a new tab)
Inspection carried out on 07 January to 12 February 2020 During an inspection of Acute wards for adults of working age and psychiatric intensive care units Download report PDF (opens in a new tab)Download report PDF (opens in a new tab)
Inspection carried out on 07 January to 12 February 2020 During an inspection of Long stay or rehabilitation mental health wards for working age adults Download report PDF (opens in a new tab)Download report PDF (opens in a new tab)
Inspection carried out on 07 January to 12 February 2020 During an inspection of Mental health crisis services and health-based places of safety Download report PDF (opens in a new tab)Download report PDF (opens in a new tab)
See more service reports published 1 May 2020
Service reports published 12 April 2019
Inspection carried out on 11th December 2018 to 17th January 2019 During an inspection of Acute wards for adults of working age and psychiatric intensive care units Download report PDF (opens in a new tab)Download report PDF (opens in a new tab)
Inspection carried out on 11th December 2018 to 17th January 2019 During an inspection of Specialist community mental health services for children and young people Download report PDF (opens in a new tab)Download report PDF (opens in a new tab)
Inspection carried out on 11th December 2018 to 17th January 2019 During an inspection of Mental health crisis services and health-based places of safety Download report PDF (opens in a new tab)Download report PDF (opens in a new tab)
Inspection carried out on 11th December 2018 to 17th January 2019 During an inspection of Wards for older people with mental health problems Download report PDF (opens in a new tab)Download report PDF (opens in a new tab)
See more service reports published 12 April 2019
Service reports published 6 July 2018
Inspection carried out on 1 May 2018 During an inspection of Acute wards for adults of working age and psychiatric intensive care units Download report PDF (opens in a new tab)
Service reports published 25 April 2018
Inspection carried out on 9-11 January 2018 During an inspection of Wards for people with a learning disability or autism Download report PDF (opens in a new tab)
Service reports published 10 August 2017
Inspection carried out on 5 April 2017 to 7 April 2017 Follow up visit 27 April 2017 During an inspection of Acute wards for adults of working age and psychiatric intensive care units Download report PDF (opens in a new tab)
Service reports published 3 August 2017
Inspection carried out on 5-7 April 2017 During an inspection of Wards for older people with mental health problems Download report PDF (opens in a new tab)
Service reports published 17 July 2017
Inspection carried out on 14-23 February 2017 & 3 March 2017 During an inspection of Substance misuse services Download report PDF (opens in a new tab)
Service reports published 13 April 2017
Inspection carried out on 14 November 2016 to 15 November 2016 During an inspection of Reference: not found Download report PDF (opens in a new tab)
Service reports published 29 July 2016
Inspection carried out on 1-4 March 2016 During an inspection of Mental health crisis services and health-based places of safety Download report PDF (opens in a new tab)
Service reports published 28 July 2016
Inspection carried out on 1 to 3 March 2016 During an inspection of Long stay or rehabilitation mental health wards for working age adults Download report PDF (opens in a new tab)
Inspection carried out on 01 March 2016 During an inspection of Wards for people with a learning disability or autism Download report PDF (opens in a new tab)
Inspection carried out on 1-3 March 2016 During an inspection of Acute wards for adults of working age and psychiatric intensive care units Download report PDF (opens in a new tab)
Inspection carried out on 29 February to 4 March 2016 During an inspection of Community mental health services with learning disabilities or autism Download report PDF (opens in a new tab)
Inspection carried out on 29 February to 3 March 2016 During an inspection of Community-based mental health services for adults of working age Download report PDF (opens in a new tab)
Inspection carried out on 29 February – 4 March 2016 During an inspection of Wards for older people with mental health problems Download report PDF (opens in a new tab)
Inspection carried out on 29 February – 4 March 2016 During an inspection of Community-based mental health services for older people Download report PDF (opens in a new tab)
Inspection carried out on 1-4 March 2016 During an inspection of Specialist community mental health services for children and young people Download report PDF (opens in a new tab)
See more service reports published 28 July 2016
Inspection carried out on 11th December 2018 to 17th January 2019

During a routine inspection

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

  • We rated all five domains – safe, effective, caring, responsive and well-led – as good. Following this inspection all ten of the trust’s core services were rated as good. In rating the trust, we took into account the previous ratings of the six mental health services not inspected this time.
  • Eleven of the 12 care homes provided by the trust are rated good and one is rated requires improvement.
  • Since the last well-led inspection in 2017 the trust has continued to make improvements.
  • Staff at all levels and across all services had renewed pride and confidence in their work and spoke with energy and enthusiasm about the improvements that they were delivering.
  • There was stronger leadership at executive, divisional and service delivery levels throughout the trust.
  • The trust had more robust operational systems and processes. The trust had responded to emerging issues in service quality with considered, well-executed and in-depth supportive plans for improvement.
  • The trust had introduced a culture of quality improvement.
  • The trust had continued to modernise and improve the environments from which they delivered community and inpatient services.

However:

  • The wards at the Abraham Cowley Unit in Chertsey were not suitable for modern mental health care. The staff had implemented many procedures to mitigate this but the physical construction of the building meant there were blind spots which were difficult to observe easily and its layout did not fully promote dignity and privacy due to the dormitory bedrooms.

Inspection carried out on 25-26 July 2017

During an inspection looking at part of the service

Following this re-inspection we have changed the rating of well led at provider level from requires improvement to Good. We rated Surrey and Borders Partnership NHS Foundation Trust as good overall for caring, effective, responsive and well led because:

  • The trust had a clear set of values and a vision and the trust had strong leadership, with effective leaders and managers. The board presented as passionate and engaging and were open and transparent. Executive directors and non-executive directors understood their roles and responsibilities.

  • The trust values included involving people in their work and involvement groups were embedded in governance arrangements. The trust had set up initiatives to get feedback from patients and carers.

  • The trust had robust governance structures in place. This meant that from ward to board there was a good understanding of the challenges facing the trust. Areas for improvement were recognised and work was carried out to make all the necessary changes. Key performance indicators and quality standards were set by the trust board annually. These included clinical priorities for improving services. The trust monitored progress against each of the key performance indicators and quality standards at the council of governors, executive board, operational board and trust board meetings. The trust had a systematic programme of clinical and internal audit which was used to monitor quality and systems to identify where action should be taken.

  • The trust had made considerable improvements in the quality of care and treatment provided at all of their care homes for people with a learning disability. In addition reporting systems and internal assurance reports had been strengthened which ensured members of the trust board were well versed in any developments, concerns or issues relating to the care homes.

  • The trust board had a thorough and current oversight of all incidents and complaints. The board examined and analysed all incidents and complaints through regular and detailed board reports.

Inspection carried out on 1-4 March 2016

During a routine inspection

We rated Surrey and Borders Partnership NHS Foundation Trust as requires improvement because:

  • The board did not have a thorough oversight of incidents and complaints. Whilst the board discussed individual, high profile cases and received annual reports of incidents and complaints, there was no detailed regular report to the board which examined and analysed all incidents and complaints. This meant that board members were not aware of all trends or hot spots and could not adequately challenge each other on what needed to change or the lessons that should be learned from serious incidents and complaints.
  • The trust had weaknesses in their systems for reporting and learning from incidents. Some incidents logged by staff were not signed off by managers which resulted in a backlog. This means that the initial actions and learning from some incidents were not captured and documented.

  • The trust’s seclusion policy did not reflect the updates to the changes to the Mental Health Act Code of Practice.

  • There was no consistent use of a recognised risk assessment tool or consistent recording of patient risk across all core services. In the community child and adolescent mental health service and the mental health crisis and place of safety teams there were poor risk assessments.

  • Medicines management practice was inconsistent across the trust. Issues included controlled drugs discrepancies on two wards and out of date drugs on three wards. Fridge temperatures were not recorded correctly at three sites.

  • There were weaknesses in the trust’s oversight of its social care homes for people with a learning disability. Six of the trust’s social care homes have been rated as requires improvement by separate CQC inspections in the past year. Prior to our inspections, the trust’s quality assurance systems had highlighted some concerns at these services but had not identified all of the concerns or the severity of some of the issues.

However:

  • The trust had carried out a comprehensive review of its inpatient services and health based places of safety since our last inspection. The trust had closed wards and units that were not safe or no longer suitable for inpatient mental health services and had opened a new purpose built unit for adult acute services, the psychiatric intensive care unit and a health based place of safety.

  • Access to physical healthcare and monitoring of physical health had improved in the trust since our last inspection.

  • There were good waiting times and response times particularly for community services.

  • The trust had good leadership, with strong and effective leaders and managers. They presented as passionate and engaging and were open and transparent.

We will be working with the trust to agree an action plan to assist them in improving the standards of care and treatment.

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


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


Mental Health Act Commissioner reports

Each year, we visit all NHS trusts and independent providers who care for people whose rights are restricted under the Mental Health Act to monitor the care they provide and check that patients' rights are met. Immediate concerns raised by patients on those visits are discussed, if appropriate, with hospital staff.

Our Mental Health Act Commissioners may carry out a number of visits to each provider over a 12-month period, during which they talk to detained patients, staff and managers about how services are provided. In the past, we summarised themes from the visits and published an annual statement followed by the provider's response where applicable. We are looking at different ways to indicate the outcomes of our monitoring in the future.