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Provider: Bradford District Care NHS Foundation Trust Requires improvement

On 15 September 2014, we published our inspection reports for Bradford District Care Trust.

Read the 2014 service reports

Reports


Inspection carried out on 28 Feb to 10 Apr 2019

During a routine inspection

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

  • We rated the trust as requires improvement overall in safe, effective and well led. We rated caring and responsive as good. Our rating for the trust took into account the current ratings of the services not inspected this time.
  • We rated well-led for the trust overall as requires improvement.
  • Of the 14 core services, one is rated as inadequate and five as requires improvement, taking into account the current ratings of the services not inspected at this time. Of the eight core services inspected during this most recent inspection, one was rated as inadequate and three were rated as requires improvement.
  • Overall ratings went down for the acute inpatient mental health services for adults of working age and the psychiatric intensive care unit to inadequate, and for the community health services for children and young people to requires improvement. The forensic low secure services were rated as requires improvement. The rating stayed requires improvement for the wards for older people with a mental health problem.
  • Due to the concerns we found during our inspection of the trust’s acute inpatient mental health wards for adults of working age and psychiatric intensive care unit, we used our powers to take immediate enforcement action. We issued the trust with a Section 29A warning notice. This advised the trust that our findings indicated a need for significant improvement in the quality of healthcare. We will revisit these services to check that appropriate action has been taken and that quality of care has improved. However, by the time of the well-led review the trust had already taken significant action to address the issues identified in the warning notice.
  • The trust was not providing consistently safe care, particularly on the inpatient mental health wards. Issues identified included ligature and environmental risks not being identified and managed, the maintenance of premises and equipment, medicines management, blanket restrictions that were not individually risk assessed, no alarms for patients to call staff in an emergency.
  • The trust did not have effective systems in place to investigate incidents within appropriate timescales to identify learning from incidents and make improvements.
  • The trust was not consistently providing effective care. The trust had failed to address concerns identified in the 2017 inspection in relation to staff supervision and audit of the Mental Capacity Act. Staff understanding and adherence to the Act was inconsistent.
  • The arrangements for governance and performance management did not always operate effectively. Whilst there had been a recent review of governance arrangements the plans to change these were in the early stages and were not embedded at the time of the inspection.
  • The trust did not always deal with risk issues and poor performance appropriately. Senior leaders were not aware of all the concerns found during the inspection. Areas for improvement identified at the last inspection in 2017 had not been addressed at the time of this inspection.

However:

  • We rated community health services as outstanding overall for caring. We rated community end of life care services as outstanding overall. Three of the six mental health core services we inspected were rated as good. There were improvements in the overall ratings for the trust’s wards for people with a learning disability or autism and mental health crisis services and health-based places of safety. The community mental health services for older people with a mental health problem were also rated as good.
  • Two of the trust’s services were rated as outstanding for caring, and 11 were rated as good. (This took into account the current ratings of the six services not inspected this time.)
  • Staff interactions with patients we observed were kind, respectful and compassionate. Feedback from patients and those close to them was continually positive in almost all the services we inspected about the care provided. Feedback from patient and carer surveys was positive.
  • Staff found innovative ways to enable people to manage their own health and care, particularly in those services rated as outstanding.
  • Most of the trust’s core services were providing care in a way that was responsive to patients’ individual needs. The community end of life care services were rated as outstanding in the responsive key question.
  • The directors of the trust had completed all the checks needed to work at that level. They all had disclosure and barring service certificates and met the fit and proper person requirements.
  • The trust had implemented a new vision and strategy and had plans to improve services. Staff knew and understood the provider’s vision and values.
  • The trust actively engaged in collaborative work with regional and place-based external partners to agree joint health and care priorities to support the delivery of high-quality, sustainable care and treatment, and to meet the needs of the local population.


CQC inspections of services

Service reports published 8 November 2019
Inspection carried out on 10-12 September 2019 During an inspection of Acute wards for adults of working age and psychiatric intensive care units Download report PDF | 280.05 KB (opens in a new tab)
Service reports published 11 June 2019
Inspection carried out on 28 Feb to 10 Apr 2019 During an inspection of Acute wards for adults of working age and psychiatric intensive care units Download report PDF | 633.78 KB (opens in a new tab)Download report PDF | 2.5 MB (opens in a new tab)
Inspection carried out on 28 Feb to 10 Apr 2019 During an inspection of Community end of life care Download report PDF | 633.78 KB (opens in a new tab)Download report PDF | 2.5 MB (opens in a new tab)
Inspection carried out on 28 Feb to 10 Apr 2019 During an inspection of Forensic inpatient or secure wards Download report PDF | 633.78 KB (opens in a new tab)Download report PDF | 2.5 MB (opens in a new tab)
Inspection carried out on 28 Feb to 10 Apr 2019 During an inspection of Mental health crisis services and health-based places of safety Download report PDF | 633.78 KB (opens in a new tab)Download report PDF | 2.5 MB (opens in a new tab)
Inspection carried out on 28 Feb to 10 Apr 2019 During an inspection of Wards for people with a learning disability or autism Download report PDF | 633.78 KB (opens in a new tab)Download report PDF | 2.5 MB (opens in a new tab)
Inspection carried out on 28 Feb to 10 Apr 2019 During an inspection of Community-based mental health services for older people Download report PDF | 633.78 KB (opens in a new tab)Download report PDF | 2.5 MB (opens in a new tab)
Inspection carried out on 28 Feb to 10 Apr 2019 During an inspection of Community health services for children, young people and families Download report PDF | 633.78 KB (opens in a new tab)Download report PDF | 2.5 MB (opens in a new tab)
Inspection carried out on 28 Feb to 10 Apr 2019 During an inspection of Wards for older people with mental health problems Download report PDF | 633.78 KB (opens in a new tab)Download report PDF | 2.5 MB (opens in a new tab)
See more service reports published 11 June 2019
Service reports published 12 February 2018
Inspection carried out on October 4th - November 8th During an inspection of Community health services for adults Download report PDF | 607.49 KB (opens in a new tab)Download report PDF | 2.58 MB (opens in a new tab)
Inspection carried out on October 4th - November 8th During an inspection of Wards for people with a learning disability or autism Download report PDF | 607.49 KB (opens in a new tab)Download report PDF | 2.58 MB (opens in a new tab)
Inspection carried out on October 4th - November 8th During an inspection of Mental health crisis services and health-based places of safety Download report PDF | 607.49 KB (opens in a new tab)Download report PDF | 2.58 MB (opens in a new tab)
Inspection carried out on October 4th - November 8th During an inspection of Acute wards for adults of working age and psychiatric intensive care units Download report PDF | 607.49 KB (opens in a new tab)Download report PDF | 2.58 MB (opens in a new tab)
Inspection carried out on October 4th - November 8th During an inspection of Community mental health services with learning disabilities or autism Download report PDF | 607.49 KB (opens in a new tab)Download report PDF | 2.58 MB (opens in a new tab)
Inspection carried out on October 4th - November 8th During an inspection of Community-based mental health services for adults of working age Download report PDF | 607.49 KB (opens in a new tab)Download report PDF | 2.58 MB (opens in a new tab)
Inspection carried out on October 4th - November 8th During an inspection of Long stay or rehabilitation mental health wards for working age adults Download report PDF | 607.49 KB (opens in a new tab)Download report PDF | 2.58 MB (opens in a new tab)
Inspection carried out on October 4th - November 8th During an inspection of Community dental services Download report PDF | 607.49 KB (opens in a new tab)Download report PDF | 2.58 MB (opens in a new tab)
Inspection carried out on October 4th - November 8th During an inspection of Wards for older people with mental health problems Download report PDF | 607.49 KB (opens in a new tab)Download report PDF | 2.58 MB (opens in a new tab)
See more service reports published 12 February 2018
Service reports published 8 June 2016
Inspection carried out on 11, 12 and 13 January 2016 During an inspection of Mental health crisis services and health-based places of safety Download report PDF | 206.07 KB (opens in a new tab)
Inspection carried out on 11, 12 and 13 January 2016 During an inspection of Acute wards for adults of working age and psychiatric intensive care units Download report PDF | 209.02 KB (opens in a new tab)
Inspection carried out on October 4th - November 8th

During a routine inspection

Our rating of the trust went down. We rated it as requires improvement because:

  • We rated six of the 14 core services provided by the trust as requires improvement overall. This takes account of the ratings of core services that we did not inspect this time.
  • We rated safe, eff ective and well-led as requires improvement for the trust overall. Our rating for the trust took into account the current ratings of services not inspected this time.
  • We rated well-led at the trust level as requires improvement. The trust’s senior leadership team did not have eff ective oversight of staff training, staff supervision and of restrictive interventions in inpatient services. The trust had not ensured that all staff had checks with the disclosure and barring service in line with trust policy. The trust had not ensured that documentation was maintained in line with the fit and proper persons requirements. There was an inconsistent approach to audits in relation to the use of the Mental Health Act and Mental Capacity Act. The trust had not updated all active policies to reflect the changes to the Mental Health Act Code of Practice in 2015. The trust had not ensured that all serious incidents were reviewed in line with the requirements of the duty of candour and that serious incidents were investigated appropriately and eff ectively.
  • Services were not consistently managing risks safely. Risk assessments were not always completed or reviewed regularly. Staff were not consistently trained in line with the trust’s requirements. Services had high sickness, vacancy and turnover rates and some relied on agency and bank staff to maintain safe staff ing levels. Staff were not consistently recognising and reporting safeguarding concerns to external agencies. Staff had a mixed understanding of the duty of candour.
  • Services were not consistently providing eff ective care. Care records in some services contained information that was incomplete or had not been reviewed for some time. Not all care plans were holistic and centred on the individual needs of the patient. Not all staff were regularly receiving supervision in line with the trust policy. Staff had a mixed understanding of the Mental Health Act and Mental Capacity Act.

However:

  • The staff showed a caring attitude to those who used the trust services. Feedback from people using services and their relatives and carers was highly positive. Staff in all services were kind, compassionate, respectful and supportive. People who used services were appropriately involved in making decisions about their care.
  • The trust had ensured that services were responsive to meet the needs of people. Services were planned so that local people could access services when they needed them. There was a systematic approach to managing access to services which was based on individual needs. The trust had ensured there was a clear pathway so that people were transferred appropriately between services.

Inspection carried out on 11, 12 and 13 January 2016

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

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.

The Care Qualty Commission conducted this announced focused inspection to review two requirement notices given at our last comprehensive inspection in June 2014. These related to breaches of Regualtion 9 Person-centred care and Regulation 15 Premises and equipment. The breach of Regulation 9 was found in the adult acute services and this related to people’s needs not being met in a timely manner due to inconsistent medical care. The breach of Regulation 15 was in relation to the health based places of safety not meeting the Royal College of Psychiatrists guidance to assure against the risks of unsafe or unsuitable premises.

The methodology we use to inspect in June 2014 has changed and the core services were different. For example, psychiatric intensive care units (PICU) and health based places of safety (HBPoS) were inspected under the same core service. Health based places of safety are now inspected in the same core service as mental health crisis services. As the requirement notices did not relate to mental health crisis services, we did not visit any of them during this inspection.

Following the inspection in June 2014, the trust submitted action plans to us telling us how they would make improvements. This also covered areas where we had made recommendations.

We inspected the trust on 11, 12 and 13 January 2016. We visited five adult acute ward areas and two HBPoS. We spoke with staff of different grades, spoke with patients using the service and looked at care records.

We visited the following ward areas;

  • Fern and Heather wards at The Airedale Centre for Mental Health
  • Maplebeck, Ashbrook and Clover wards at Lynfield Mount Hospital
  • We also visited two HBPoS which are based across both sites.

We found the trust had met the requirement notices. The HBPoS environments had been refurbished and now meet the Royal College of Psychiatrists guidance. The trust had made improvements relating to the availability of medical staff to review patients on the acute wards. We reviewed the actions plans submitted by the trust to meet recommendation made by us in June 2014 and found these had also been completed.

This meant we were able to re-rate the trust at this inspection as we found they had taken sufficient action to ensure all areas of concern had been addressed.

Inspection carried out on 17 to 19 June, 1 July and 3 July 2014

During a routine inspection

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

We saw that the trust was not always providing a safe service for people across some of the services it provided. This included the children and adolescent mental health service, the long stay/forensic/secure mental health service and the health based place of safety. We identified robust systems in place for managing risks within the trust. Clear protocols were established for the identification and investigation of safeguarding concerns. Staff were aware of their role in proactively identifying and reporting risks. However within the children’s and young people’s community service, staff we spoke with were concerned about the low number of new referrals accepted by the local authority, which they felt placed them at risk. The trust told us they will undertake a review of these concerns and talk with the local authority. We also found that in the children and adolescent mental health service and the long stay/forensic/secure services that risks were not always fully assessed or reviewed by staff. We have issued a compliance action in relation to the health based place of safety due to issues with ligature risks and received assurances that these risks would be addressed.  We did not find wider organisational or systemic concerns about safety.

Overall, trust staff adhered to the requirements of the Mental Capacity Act 2005 to assess capacity to consent and work within best interest considerations where people lacked capacity; but in community health and learning disabilities services this could not always be evidenced.  We visited most of the wards at each location where detained patients were being treated. In the majority of the care records we reviewed, which related to the detention, care and treatment of detained patients, the principles of the Mental Health Act (MHA) and the MHA Code of practice had been followed and adhered to. 

We saw that the trust was providing evidence based treatments in line with best practice guidance. We saw that people were being supported to make choices and gave informed consent where possible. Evidence was seen of effective outcome measures being used throughout the trust in most of the services. The exceptions were within learning disability services where outcomes were unclear and assessments of capacity were not detailed and community health services where we found similar issues regarding capacity assessments and supervision of staff was not always occurring.  The trust employed appropriately qualified and trained staff throughout their services. There were good systems to ensure adherence with the Mental Health Act 1983 when people were compulsorily detained. 

We saw that overall the trust was providing a caring service for people across all core locations. Throughout the inspection we saw examples of staff treating people with kindness, dignity and compassion. The feedback received from people who used services and their visitors was generally positive about their experiences of the care and treatment provided by the trust.

We saw that the trust was not always responsive to people’s needs across some of the services it provided but this appeared to be a transient problem due to the development of administrative hubs. Throughout the inspection we noted that the trust had organised services so that they met the needs of the local population based on the resources it had. We saw outstanding care for people receiving end of life care.  Patients were highly complementary of the service and confirmed they had received a coordinated and seamless service with 24 hour access to ‘The Gold Line’ service. We found that mostly people’s individual needs and wishes were met when the trust assessed, planned and delivered care and treatment to people.  However recent changes to services including integrated care, single point of access and a move to administrative hubs meant that people had experienced (and still had to experience) longer than necessary delays in getting the care and treatment they required, particularly on the acute mental health wards and in community health services. Service users reported difficulty accessing crisis mental health services at night.  The crisis team offered only telephone contact at night.  Those who needed immediate assessment were directed to the emergency department at Bradford Royal Infirmary and Airedale General Hospital; where they might have to wait a long time to be assessed by the liaison psychiatry team because these services were not commissioned on a 24 hour basis.

We saw that overall the trust was well led with proactive and responsive trust wide leadership. There was a clear governance arrangements in place that supported the safe delivery of the service and to monitor and improve trust performance. Lines of communication from the board and senior managers to frontline services were mostly effective. Staff felt engaged with the trust and were well supported by local managers. We saw some recent good examples  where board members spent time within services to understand the challenges faced and were actively engaging with front line staff including clinical buddying, walk abouts by the non executive directors and the culture conversations initiated recently by the chief executive officer. Staff felt well supported by their immediate line managers. However the organisations vision and values were not fully embedded across all community health teams.  The recent scale and pace of change within the organisation was continuing to cause difficulties for the front line community mental health team staff. There had not been the appropriate level of engagement from leaders to ensure that this change was managed well.   The scale and pace of change had also caused difficulties for service users in terms of accessing services and communicating with people within teams.  We saw that there had been some recent improvements and a commitment to make these changes work including increasing trust board oversight and ownership of these issues.

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.


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.