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Provider: Dudley and Walsall Mental Health Partnership NHS Trust Good

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 24 Sep to 14 Nov 2018

During a routine inspection

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

• The trust had made all the necessary improvements since the previous inspection in November 2016. We rated safe, effective, caring, responsive, and well led as good. We saw an improvement in the overall rating for acute wards for adults of working age and PICU from requires improvement to good.

• We rated all five of the trust’s seven core services we inspected as good. In rating the trust, we took into account the previous ratings of the core services not inspected this time.

• The trust ensured that risk assessments were completed and updated regularly. Staff updated risk assessments for each patient to understand how to best support them. Staff had good access to patient records and stored them safely. Staff knew how to keep patients safe and reported incidents, including abuse, when necessary. Staff learnt lessons from incidents.

• Care planning was individualised and regularly updated. A range of care and treatment interventions was delivered in line with guidance from the National Institute for Health and Care Excellence.

• The majority of staff had good knowledge of the Mental Health Act, the Mental Capacity Act and the Deprivation of Liberty Safeguards. Staff were up to date with training in the Mental Health Act and Mental Capacity Act.

• Staff were kind, compassionate and respectful and protected the privacy and dignity of people using services. Patients and those close to them were involved in decisions about their care, treatment.

• Services were planned to address the needs of local people and the trust had a good understanding of the needs of patients in their community. Staff ensured that service users and carers received the help they needed through good communication, advocacy and appropriate cultural support.

• There was a robust complaints process that supported patients and carers to complain and raise concerns. The trust provided information to patients and their families to better understand services available to them.

• There was good leadership across the trust from the board to front line managers with the right skills to undertake their roles. The board had good understanding of performance, which appropriately covered and combined their views with information on quality, operations and finances.

However:

• The acute wards for adults of working age had high numbers of vacancies for qualified staff.

• Medical staff in the CAMHS did not use the electronic records system that the rest of the team used, instead they kept paper records.

• Staff working in the wards for adults of working age did not receive regular supervision.

• Wards at Bloxwich hospital had multiple occupancy rooms. The ward environments there also offered less space for patients and activities. However, the trust was planning to address the issue through the commissioning of a new building. This intent would need to be fulfilled to address these limitations.


CQC inspections of services

Service reports published 7 February 2019
Inspection carried out on 24 Sep to 14 Nov 2018 During an inspection of Acute wards for adults of working age and psychiatric intensive care units Download report PDF | 412.51 KB (opens in a new tab)Download report PDF | 1.42 MB (opens in a new tab)
Inspection carried out on 24 Sep to 14 Nov 2018 During an inspection of Community-based mental health services for adults of working age Download report PDF | 412.51 KB (opens in a new tab)Download report PDF | 1.42 MB (opens in a new tab)
Inspection carried out on 24 Sep to 14 Nov 2018 During an inspection of Wards for older people with mental health problems Download report PDF | 412.51 KB (opens in a new tab)Download report PDF | 1.42 MB (opens in a new tab)
Inspection carried out on 24 Sep to 14 Nov 2018 During an inspection of Specialist community mental health services for children and young people Download report PDF | 412.51 KB (opens in a new tab)Download report PDF | 1.42 MB (opens in a new tab)
Inspection carried out on 24 Sep to 14 Nov 2018 During an inspection of Mental health crisis services and health-based places of safety Download report PDF | 412.51 KB (opens in a new tab)Download report PDF | 1.42 MB (opens in a new tab)
See more service reports published 7 February 2019
Service reports published 28 March 2017
Inspection carried out on 14- 16 November 2016 During an inspection of Acute wards for adults of working age and psychiatric intensive care units Download report PDF | 399.39 KB (opens in a new tab)
Inspection carried out on 14 – 16 November 2016 During an inspection of Mental health crisis services and health-based places of safety Download report PDF | 329.23 KB (opens in a new tab)
Inspection carried out on 1-2 December 2016 During an inspection of Wards for older people with mental health problems Download report PDF | 245.64 KB (opens in a new tab)
Inspection carried out on 14th and 15th November 2016. During an inspection of Specialist community mental health services for children and young people Download report PDF | 232.26 KB (opens in a new tab)
Inspection carried out on November 28 and 29 2016 During an inspection of Community-based mental health services for older people Download report PDF | 259.44 KB (opens in a new tab)
See more service reports published 28 March 2017
Service reports published 19 May 2016
Inspection carried out on 1- 5 February 2016 During an inspection of Community-based mental health services for older people Download report PDF | 316.39 KB (opens in a new tab)
Inspection carried out on 1- 5 February 2016 During an inspection of Wards for older people with mental health problems Download report PDF | 309.24 KB (opens in a new tab)
Inspection carried out on 1st-5th February 2016 During an inspection of Acute wards for adults of working age and psychiatric intensive care units Download report PDF | 428.2 KB (opens in a new tab)
Inspection carried out on 1 February – 5 February 2016 During an inspection of Mental health crisis services and health-based places of safety Download report PDF | 328.17 KB (opens in a new tab)
Inspection carried out on To Be Confirmed During an inspection of Community-based mental health services for adults of working age Download report PDF | 316.52 KB (opens in a new tab)
Inspection carried out on 1-5 February 2016 During an inspection of Specialist community mental health services for children and young people Download report PDF | 314.06 KB (opens in a new tab)
See more service reports published 19 May 2016
Inspection carried out on 14 - 16 November 2016

During an inspection to make sure that the improvements required had been made

Following the inspection in November 2016, we have changed the overall rating for Dudley and Walsall Mental Health Partnership NHS Trust from requires improvement to good because:

  • The trust had made improvements to the documentation of long-term segregation and the management of blanket restrictions on the adult acute wards. The trust had revised all blanket restrictions and new protocols were now in place. Long-term segregation occurs when a patient is not allowed to mix freely with other patients on the ward on a long-term basis due to reduce the risk they pose to others. Blanket restrictions are rules or restrictions placed on all patients within a ward with no individual assessment considered.
  • Since our inspection in February 2016, the trust had reduced the specialist community services for children and young people’s waiting lists. We found that although waiting lists existed, teams had made significant reductions.
  • The staff throughout the trust displayed a dedicated and caring attitude towards people who used the services. We saw several examples of staff being respectful and inclusive. Feedback from patients, carers and families also reflected this.

  • The core services we inspected were responsive to the needs of the people who used them. The trust demonstrated listening and learning from complaints. Patients we spoke with knew how to raise concerns and complaints, and said staff gave them feedback.

  • We also carried out a ‘well led’ review and found the leadership across the trust at a senior management level had continued to develop a new positive culture of leadership. We found in most of the services we visited that staff morale was good and staff reported managers supporting them to carry out their roles effectively.

However:

  • Although some teams had made improvements regarding care plans and risk assessments, we found that the consistency and quality of documentation across the services we inspected had not improved significantly. We found examples of missing, incomplete, out-of-date risk assessments and care plans that were not recovery orientated.
  • In some teams, the management of medicines and emergency equipment was not always safe. We found that staff did not always regularly check and seal emergency equipment using a tamper proof seal.
  • In the older people’s community services, not all of the recommendations made in previous inspection reports had been put in place. We found that managers had not provided an introduction to physical health education to unqualified staff, or personal safety training to all staff in teams. They had not updated their lone working policy before planned extended working hours in the Walsall team.

  • Although the trust had made a degree of improvement with regard to the monitoring of mandatory training, we found some teams’ compliance remained below the trust target. The adult acute wards Mental Health Act training remained below trust target and staff did not fully follow the principles of the Mental Capacity Act.

  • Although staffing had generally improved in areas where this had previously been a concern, occupational therapists and psychologists remained concerned that they lacked the capacity to effectively function in their roles and in multidisciplinary teams.

Inspection carried out on 1-5 February 2016

During a routine inspection

When aggregating ratings, our inspection teams follow a set of principles to ensure consistent decisions. The principles will normally apply but will be balanced by inspection teams using their discretion and professional judgement in the light of all of the available evidence.

We found that the Dudley & Walsall Mental Health Partnership NHS Trust was performing at a level, which led to a judgement of Requires Improvement.

We rated the safety of services as requires improvement; partly as we consistently found the recording and review of individual patient risk to be of a poor standard. We also found that team bases were not always safe as some lacked alarm systems; which compromises the safety of both staff and visitors.

The quality and effectiveness of care planning was inconsistent. We found that care plans were not always holistic, person centred or recovery focused. We also found issues with the application of the Mental Health Act in relation to blanket restrictions and staffs’ understanding of the rights of informal patients who wished to leave the acute wards.

Staff were consistently caring and treated patients with kindness, dignity & respect. The Trust was very proactively working on patient and carer engagement and had introduced several initiatives such as experts by experience, youth forums and involved those who used services in the recruitment of staff.

We found the trust services to be responsive to the needs of the people who used services. Overall, access to services was achieved in a timely manner and the trust had improved delays when discharging patients. In most services, patients had access to a range of activities and therapies.

We found the trust to be well led. We were particularly impressed with the interim chief executive. Staff and patients spoke very highly of the changes that he has introduced since coming into post 6 months prior to the inspection. We did however conclude that governance processes were not always robust or fully embedded throughout the trust.

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

Inspection carried out on 25 and 26 February 2014

During a routine inspection

Bushey Fields Hospital

Core service provided: Three acute admission wards; Two older people's wards; One Health Based Place of Safety

Male/female/mixed: male/female/mixed

Capacity: 99

Dorothy Pattison Hospital

Core service provided: Two acute admission wards; One Longstay/forensic/Secure services ward; One Health Based Place of Safety

Male/female/mixed: male/female/mixed

Capacity: 52

Bloxwich Hospital

Core service provided: Two older people's wards

Male/female/mixed: mixed

Capacity: 40

The trust has three main hospital sites: Bushey Fields Hospital in Dudley, Dorothy Pattison Hospital in Walsall and Bloxwich Hospital in Walsall. There are 191 beds; of which five are extra care area beds for people who require intensive nursing because their mental health problems have caused them to become agitated. The overall level of bed occupancy is lower than the national average (81% compared to the England average of 85%).

The trust also has staff based in about 28 locations across the two boroughs who provide care to people who live in their own homes.

The trust provides core mental health services and additional services such as Substance Misuse and Military Veterans services.

At the time of the inspection, the Board was leading work to change the way in which the trust’s services are organised. These changes had unsettled some staff; some staff that we talked to reported feeling unsupported by the trust and did not feel confident that if they raised concerns that they would be listened to and treated fairly. During the course of the inspection, we received some whistleblowing information from a number of staff across different disciplines and locations. Some staff reported to us that they felt ‘fearful and frightened of the culture within the organisation’ and were reluctant to raise concerns in fear of reprisal. Some staff reported this as ‘bullying’. However other staff reported that they felt very engaged.

The Non-Executive Directors (NED’s) were able to describe to us the information flows and how they challenged what they did not understand. The NED’s had a very robust understanding of all of the issues that the trust was facing and how they were to be tackled but always with an eye on quality.We concluded that the non-executive directors were a strong group who understood their role and exercised their duties effectively.

The trust had a robust approach to learning from incidents and ensured this was embedded in practice across all levels.

Although the trust ensured that all staff undertook mandatory training, it did not always meet the need for specific specialist training. For example, those working in older people’s services had not been trained in dementia care and we concluded that this had an impact on the quality of care received by people using this service.

The trust worked well with other local stakeholders, such as the local authorities and the clinical commissioning groups and we saw evidence of good multi-disciplinary team working; particularly between adult inpatient and community services.

With a few exceptions, we found that the trust’s staff were caring and had a good approach to patient care, and interacted positively and compassionately with people. We also saw examples of the trust’s staff providing good physical healthcare.

Clinical staff recorded risk assessments for all patients but were not so good at developing management plans in line with the assessments.

During our inspection we observed that some patients, on wards for both younger and older adults, were being secluded (nursed in isolation from other patients) without the safeguards and checks set out in the Mental Health Act Code of Practice being followed.

Before our inspection, the trust had identified problems with provision for older people and we agreed that this was the case for both inpatient and community services. Temporary nurses work many shifts on the older people’s wards at Bushey Fields hospital due to unfilled staff vacancies. We observed restrictive practices on both Malvern and Holyrood wards and we concluded that patients’ dignity and privacy were not always respected on Holyrood ward. The latter was due to a combination of an unsafe ward environment and staff practices. We also concluded that there was no clear vision for the future of community mental health services for older people in Dudley and Walsall.

The quality of mental health care provided to children and adolescents was good but was only available during office hours. Young people with a mental health problem could not access specialist help out of hours and there was no intensive home care provision to support children and young people in a crisis. Children and young people were waiting a long time to receive the right service after initially being referred.

We found that application of the Mental Health Act across the services was good. People were lawfully detained and had their rights read to them at the appropriate times. People’s access to independent mental health advocacy (IMHA) varied across the trust as it was not clear that a referral to IMHA had been made when people lacked capacity.

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.


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.