Coventry and Warwickshire Partnership NHS Trust

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

This means we looked for evidence that the service met people’s needs.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement.

This meant people’s needs were not always met.

The service was in breach of legal regulations in relation to person centred care (Regulation 9).

This service scored 61 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The evidence showed some shortfalls. On some wards, the service had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and our communities in order to meet these. However, staff on Woodloes felt they had been excluded from decisions about the future of the ward.

There were mixed reviews on culture within the service across the different sites. Staff on Ferndale ward at St Micheal’s Hospital reported a positive working culture. Stanley and Pembleton wards at Manor Hospital also reported this. Most staff told us they felt like valued members of the team. However, not all staff felt they had the opportunity to contribute to discussions about the strategy for their service, especially where the service was changing. For example, Woodloes ward was set to be close in order to provide more care in the community under a Hospital at Home initiative.Although the Trust had held 8 engagement sessions for staff, and 4 sessions with the senior leadership team, staff working on Woodloes ward reported that there was a lack of initial transparency around the hospital closure, and they did not feel listened to regarding decisions about the service.This affected morale. Staff were advised that they could work within the community team, however not everybody wanted to do this. Some staff left their roles in response to this. Staff were also concerned about the reduction of hospital beds for patients and the pressure this will put on the remaining wards and the overall treatment available for the local population.

The service had inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

As part of this assessment, we spoke to 3 ward managers, and the matron of the service. Leaders had the skills, knowledge and experience to perform their roles. Leaders had a good understanding of the services they managed. They could explain clearly how the teams were working to provide high quality care. They were familiar with the pathway from admission to discharge and understood the risks within this patient group.

Staff told us that leaders were visible in the service and approachable for patients and staff.

The evidence showed a good standard. The service fostered a positive culture where people felt they could speak up and their voice would be heard.

Patients and carers had opportunities to give feedback on the service they received in a manner that reflected their individual needs. Patients and carers could use complaint forms, and “I Want Great Care” (IWGC) feedback forms. These were discussed at the patient and carer experience group, where themes are identified and changes made based on findings.

All the staff we spoke to during the assessment told us they felt comfortable to speak up without fear or risk victimisation for doing so. A staff member also gave an example of when they had used the Freedom to Speak Up service regarding staffing levels. However, another staff member told us they felt they were not always listened to.

The evidence showed some shortfalls. The service valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who work for them. However, in some instances staff did not report racist abuse. This mean it was difficult for the service to monitor and address these incidents.

The service was in the process of changing some of the shift patterns to allow for some more flexible working. This was a change that was made in response to a staff survey.

One staff member told us about how they are encouraged to bring in food from their cultures to share. However, some staff who told us they often experienced racism from patients. They referred to a policy in place to support staff from Black and Ethnic Minorities but told us they often didn’t report incidents of racism as this was usually in the context of patients being mentally unwell. Therefore, staff who may experience racial abuse at work may not be given appropriate support as the need for support may not be identified through reporting.The Trust was seeking to address this by encouraging staff to report incidents involving racism.

The evidence showed significant shortfalls. Although each ward held clinical governance meetings, there was no standard format. This meant that the quality of meetings was inconsistent. There was limited oversight of restrictive practices. Some staff had struggled to familiarising themselves with the new electronic patient record. The service did not sufficiently assess and mitigate operational risks in relation to the planned closure of Woodloes Ward. However, there has recently been improvements in compliance with clinical audits.

The service had governance processes in place to provide oversight of investigations into incidents and the implementation of recommendations from these reports. This included a weekly Incident Management Group, which reported to the Trust’s Patient Safety Incident Group and Quality Forum. Staff learned lessons from incidents that were shared with the wider teams. This included contacting patients whilst on home leave and completing risk assessments.

Clinical governance meetings were held monthly across all wards. However, the quality of these minutes varied. Meetings did not follow a consistent agenda. The trust had identified this through its internal audit and was taking steps to address this. A service level clinical governance meeting was chaired by the Matron of the service. Events and incidents from all 4 wards were discussed, ensuring that senior leaders had oversight of the services. Ward managers attended a directorate level Inpatient Mental Health Quality Forum.

There was limited oversight of restrictive practices across the service. This meant there was inconsistency regarding blanket restrictions across the wards and sites. The provider informed us that they had recently introduced restrictive practice meetings to improve oversight.

There were some shortfalls noted within the use of the new Electronic Patient Record (EPR) system. The Trust has introduced a new EPR system two months before this inspection. Staff were still familiarising themselves with the new system. We observed staff struggle to locate risk assessments. Care plans for physical health either did not exist or were limited in their direction. The recording of physical health monitoring was not always consistent or completed. We observed a lack of consistent monitoring and appropriate care plans for diabetes.

The service did not always manage risks well. The older adults inpatient service did not hold a specific risk register. The Trust had identified some risks across all inpatients services that were relevant to this service, such as the risk of ligature incidents. However, the Trust had not identified any risks to the service that required monitoring and mitigation. This was despite an impending reduction of inpatients beds from 60 to 45, at a time when 38 beds were being used for patients detained under the Mental Health Act. Having only 7 beds for informal patients presented a risk that the service may find it difficult to admit patients who required inpatient care and treatment. The absence of a risk register meant there may be insufficient oversight and management of this risk.

Staff undertook or participated in local clinical audits. The audits were sufficient to provide assurance and staff acted on the results when needed. Audits were overseen and discussed in the quality improvement plan meetings which was overseen by the Head of Nursing. The Trust had recently recruited a new Head of Nursing for inpatient services.

Some audits that were non-compliant with the Trust’s targets. This was overseen and managed by creating tasks that required completing to increase compliance. Care plan audits, mental health legislation audits, weekly ward manager audits, food safety audits, patient digital monitoring audits, sharps audits and medicines management/controlled drug audits were non-compliant. However, there was noted improvement in compliance in the last 6 months for consent to treatment audits, fridge temperature check audits, health and safety checklist audits, swallowing and choking risk screening audits, and care plan notes audits.

The service had plans for emergencies. For example, there were plans in place to manage adverse weather or a flu outbreak.

The evidence showed a good standard. The service understood their duty to collaborate and work in partnership, so services work seamlessly for people. They share information and learning with partners and collaborate for improvement.

Directorate leaders engaged with external stakeholders – such as commissioners and Healthwatch.

The service worked well with community partners such as social services and community mental health teams. External people involved in patient care were invited to multi-disciplinary meetings. Care packages for discharge were completed alongside social workers. Positive behaviour support plans that were developed by the psychology team on the ward to support staff to work with patients were shared with care home upon discharge. Care home staff visited patients on the ward to facilitate a graded discharge and handover.

The evidence showed a good standard. The service focused on continuous learning, innovation and improvement across the organisation and local system. They encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contribute to safe, effective practice and research.

The trust was attempting to make improvements within the service. Staff used quality improvement methods and knew how to apply them. Quality improvement projects were taking place to improve therapeutic activity on Ferndale ward. In relation to food and fluid intake, the service was working to improve recording of intake, as well as streamline a referral process to a dietician that was in line with community processes. The service was also in the process of adopting the Culture of Care programme, which is an NHS initiative aimed at transforming inpatient mental health, learning disability, and autism services into safe, therapeutic, and equitable environments for both patients and staff.