You are here

Provider: Black Country Healthcare NHS Foundation Trust Good

Reports


Inspection carried out on Tuesday 26/11/2019 to 28/11/2019

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

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


CQC inspections of services

Service reports published 24 January 2020
Inspection carried out on Tuesday 26/11/2019 to 28/11/2019 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 Tuesday 26/11/2019 to 28/11/2019 During an inspection of Specialist eating disorders service Download report PDF (opens in a new tab)Download report PDF (opens in a new tab)
Inspection carried out on Tuesday 26/11/2019 to 28/11/2019 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 Tuesday 26/11/2019 to 28/11/2019 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)
See more service reports published 24 January 2020
Service reports published 9 January 2019
Inspection carried out on 09 July to 30 August 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)Download report PDF (opens in a new tab)
Inspection carried out on 09 July to 30 August 2018 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 09 July to 30 August 2018 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)
Inspection carried out on 09 July to 30 August 2018 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 09 July to 30 August 2018 During an inspection of Community mental health services with learning disabilities or autism Download report PDF (opens in a new tab)Download report PDF (opens in a new tab)
Inspection carried out on 09 July to 30 August 2018 During an inspection of Wards for people with a learning disability or autism Download report PDF (opens in a new tab)Download report PDF (opens in a new tab)
See more service reports published 9 January 2019
Service reports published 21 June 2018
Inspection carried out on 10th March 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 17 February 2017
Inspection carried out on 17-19 October 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 17-19 October 2016 During an inspection of Specialist community mental health services for children and young people Download report PDF (opens in a new tab)
Inspection carried out on 17 October 2016 During an inspection of Forensic inpatient or secure wards Download report PDF (opens in a new tab)
Inspection carried out on 17-19 October 2016 During an inspection of Mental health crisis services and health-based places of safety Download report PDF (opens in a new tab)
Inspection carried out on 17th to 20th October 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 17 and 18 October 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 17-20 October 2016 During an inspection of Specialist community mental health services for children and young people Download report PDF (opens in a new tab)
Inspection carried out on 17 to 19 October 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 17-20 October 2016 During an inspection of Community health services for children, young people and families Download report PDF (opens in a new tab)
See more service reports published 17 February 2017
Service reports published 26 April 2016
Inspection carried out on 16 – 20 November 2015 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 16/11/2015 During an inspection of Forensic inpatient or secure wards Download report PDF (opens in a new tab)
Inspection carried out on 16-20 November During an inspection of Specialist community mental health services for children and young people Download report PDF (opens in a new tab)
Inspection carried out on 16th- 20th November 2015 During an inspection of Community-based mental health services for older people Download report PDF (opens in a new tab)
Inspection carried out on 16th – 20th November 2015 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 16th-20th November 2015 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 16 - 20 November 2015 During an inspection of Community health services for children, young people and families Download report PDF (opens in a new tab)
Inspection carried out on 16 - 20 November 2015 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 16-20 November 2015 During an inspection of Mental health crisis services and health-based places of safety Download report PDF (opens in a new tab)
Inspection carried out on 16th November – 20th November 2015 During an inspection of Wards for older people with mental health problems Download report PDF (opens in a new tab)
See more service reports published 26 April 2016
Inspection carried out on 09 July to 30 August 2018

During a routine inspection

Our decisions on overall ratings take into account factors including the relative size of services and we use our professional judgement to reach a fair and balanced rating

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

  • Not all trust properties were clean, well-furnished and fit for the purposes of modern mental health care services. Not all staff always followed infection control procedures. Staff at Pond Lane had poor working conditions. They worked in an untidy, unclean environment with no ambient temperature control.
  • Staff were not consistent in following best practice in the use of restrictive practices. Staff on Dale Ward carried out blanket searches which were not in line with the trust policy. Patients on the psychiatric intensive care unit were only able to smoke at set times.
  • Staff did not manage medicines consistently well in two services. They did not store or keep them at the correct temperatures.
  • Staff in some services did not follow good practice in the development and use of care plans. They did not review care plans regularly and some care plans in wards for people with learning disabilities or autism, did not pay sufficient regard to the monitor of physical healthcare needs of patients relating to diet and weight gain.
  • Not all staff across services received regular managerial and clinical supervision or had an identified clinical supervision supervisor.
  • We found issues of staff knowledge in the Mental Capacity Act and Gillick Competence in some services. Staff working with children and young people in the Early Intervention Service did not have a clear understanding of Gillick Competence or understand where and why this would be applied.
  • In parts of the trust, clinical staff had to use three different electronic recording systems – together with keeping paper notes. This meant that notes were cumbersome and difficult to navigate for people who do not work regularly in the service. However, staff we spoke with were always able to find the information we requested. The trust had plans to implement an electronic patient records system.
  • We did not find evidence of a robust recruitment process for all executive directors. When the planned TCT merger ended the trust found itself without a substantive leadership team and with support from NHSI interim appointments were made from amongst senior managers within the trust.
  • The governance systems from ward to board were not sufficiently strong to have identified and rectified a number of risks. These included environmental risk assessments which were not always location specific, actions on the risk register that had not been taken and the problems with information governance. We concluded that this was a legacy of the aborted merger. During the period when work was under way to createTransforming Care Together, governance was led by the acquiring trust. When plans to merge ended, this left Black Country Partnership Foundation NHS Trust without a substantive governance lead to direct and develop new systems. The trust had since taken action to strengthen their governance structure by making a senior appointment to lead governance and improve its systems.
  • The trust used root cause analysis approach to review serious untoward incidents and mortality lacked consistent challenge at the executive level before reports were signed off. The trust had action plans in place to address this issue.
  • The role of Freedom to Speak Up Guardian was held by a trust board member and that could lead to a conflict of interest for the post holder. This had been reviewed and new plans were in place to seek an external solution.

However:

  • We concluded that the trust board was re-establishing its control of performance following the aborted merger. The trust board operated collaboratively, that meant executives and non-executive directors shared responsibility and liability for decision-making. Apart from the lapses we identified on this inspection, the board had a reasonable understanding of performance, which appropriately covered and combined people’s views with information on quality, operations, and finances.
  • The trust board were visible across the trust. We observed meetings chaired by the chief executive and heard from staff that they knew who the leaders of the trust were.
  • The trust’s vision and values pre-dated the previous plans to merge. The trust planned to refresh them with staff engagement. Staff had an understanding of the vision and values in relation to local services.
  • The trust had an equality strategy in place which they were refreshing in collaboration with patients and staff for collaborative ownership and effectiveness.
  • The trust communicated well with patients, carers, staff and stakeholders. The majority of staff groups felt they knew what was happening in the organisation. Families and carers described a varied experience of communication with staff in the trust but were praising of the support they received from the carers team.
  • The trust strived to improve quality and innovation, for example, the epilepsy improvement group to ensure that all inpatients with epilepsy had a care plan to manage the condition with standard documentation across all learning disability units.
  • The trust were proactive in attempts to employ people across many of the core services but recruitment of staff remained a challenge.
  • The trust recognised its staff in a number of ways, through a simple thank you to formal awards.
  • There was a culture of learning and research across the trust.

Inspection carried out on 17 – 19 October 2016

During a routine inspection

We have changed the overall rating for the Black Country Partnership NHS Foundation Trust from requires improvement to good because:

  • We were impressed by the trusts response to the CQC inspection report that was published in April 2016. The trust had remained open and transparent regarding their action plan to meet the requirement notices from the inspection of November 2015.
  • We found the quality and consistency of risk assessments and care plans had improved and that physical healthcare was embedded across the trust. We saw the trust was effectively engaged with patients, carers and staff.
  • The trust had improved staffing levels and reduced vacancies in the health visiting team and acute wards for adults of working age. The trust had also introduced and embedded modern matrons across services and staff we spoke with talked of the positive impact they had made.
  • We saw the trust continued to go above and beyond in some of their services to meet patient and carer needs. We were impressed by feedback about the carers group and the work they had undertook to support more than 600 families of people living in Sandwell who have mental health problems.
  • The trust can continue to be proud of the caring nature of staff and teams working with people. Consistently across the trust, people were treated with respect and dignity. We noted this, particularly in, community mental health teams for adults of working age, and specialist community mental health teams for children and young people, where we rated the caring domain as outstanding.

However:

  • We found that electronic patient care records were not embedded across the trust and there was variation of how records were kept.
  • Although there was a plan for implementing Mental Health Act training across the trust, the take up of training remained variable since the inspection of November 2015. Some policies related to the Mental Health Act were out of date although this issue was remedied immediately by the trust when we brought it to their attention.

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

Inspection carried out on 16th – 20th November 2015

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 Black Country Mental Health Partnership NHS Foundation Trust was performing at a level which led to a judgement of Requires Improvement.

The provider failed to consistently ensure that all people receiving a service were protected from potential harm due to poor environments at hallam street hospital and not consistently checking and maintaining equipment used by patients.

We found that systems to manage information governance were inconsistent; record keeping and archiving of patients files were of concern in some areas. We also found that training in the mental health act & mental capacity act was not a mandatory requirement on an ongoing basis.

The provider scored below the national average with regards to staff recommending the Trust as a place to work. Some of the staff that we spoke with felt disengaged from improvements that the leadership team are trying to embed. However, we saw evidence that the Trust is attempting to engage more effectively with staff by developing initiatives such as 20/20 events where staff were invited to participate in interactive workshops that focussed on the trusts strategic goals and objectives for the future.

We were impressed by the leadership at board level but identified that there was work required to ensure that the leadership at ward or team level was of a similar standard. The trust had implemented systems to monitor quality, safety and risk and the various committees and sub-committees which fed into the senior team enabled this. However, these processes were not fully embedded throughout the organisation.

The Trust can be proud of the caring culture within the staff group. We saw consistent evidence of people who use Trust services being treated with dignity, kindness and respect. We also saw some very good examples of services responding to the individualised and often complex needs of the patients.

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.


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.