In June 2016, the Care Quality Commission (CQC) carried out a planned inspection of many of our services. On 29 September 2016, the CQC published a report with its findings.
The Trust was rated overall as “requires improvement”. This is the same rating that has been given to over 60% of other NHS trusts in England that provide mental health and wider community services.
Our level of caring was rated as “good”, and the inspectors said they “consistently observed staff treating patients with kindness, respect, compassion and empathy.”
Both patients and carers told the inspectors that “the quality of care was positive and demonstrated a staff group who have the patients’ best interests continually in mind.”
Areas for improvement
The report outlines a number of areas where we must improve. We entered this inspection process being ready and willing to learn, and we are now making immediate changes to address the issues that the inspectors found.
All the improvements that we are making have been included in service-level action plans. Named leads and clear time-frames have been allocated to each action. Our draft action plans, and detail of actions already completed, will be submitted to the CQC to be assessed at a ‘quality summit’ – involving CQC officers, Trust directors and a wide range of stakeholders. At the summit, we will listen to our key partners and adjust and add to the action plan accordingly.
Here are some of the specific issues that were raised in the report, and examples of the actions we are taking to address them.
Leadership of the Trust
We are continuing to implement changes to the way the organisation is governed, following the employment tribunal involving the Trust. Our leadership team is working hard to improve engagement with staff, so that they feel confident about the way the Trust is run. We communicate our progress to our regulators on a monthly basis, and will continue to do so. However we recognise that we have more to do, and we are seeking to learn from other organisations that are known for good governance.
A specific focus around being ‘well led’ is how we discharge our responsibilities under the Equalities Act, and ensure we meet all the standards and submission requirements for the Workforce Race Equality Standard (WRES). We have invested in this area and our Trust Board in October received information from our new Interim Director of People and Organisational Effectiveness, who is experienced in this area and has submitted our work and improvements to date.
We have set ourselves the target of training a significant number of staff to very high standards. The report references safeguarding children training, where we already have a 92% compliance rate at level 1 and an 86% compliance rate at level 2. However we have set ourselves a target of 90% compliance at level 3 – the highest level – by March 2017 and currently have a compliance rate for level 3 of 61.8%. Following the outcome of the CQC inspection, we now have plans in place to increase that compliance rate more rapidly.
The CQC also singled out our fire warden training in our inpatient areas. We have acted swiftly on this and compliance levels now stand at 92%.
Cleanliness of inpatient (hospital) areas
In our inpatient (hospital) units, the inspection teams looked at our support and seclusion rooms – which are not in constant use, but are there when needed in an urgent situation – and found that one set of bedding had not been changed immediately after use. The bed had not been used by anyone else. We now are making sure that bedding is stripped immediately after a room is vacated.
We are extremely proud of the standards of cleanliness on our inpatient sites, which achieved ratings of between 96.37% and 99.52% earlier this year through the national PLACE (patient-led assessment of the care environment) survey.
Adult safeguarding issues
The CQC report raised issues around the security of people’s property – something we also take very seriously. During an inspection two years ago NHS Protect – the organisation that leads on work to identify and tackle crime across the health service – rated us ‘green’ to show that we were fully compliant with the national standards for security management.
The incidents identified by the CQC inspectors took place in one area and were all reported to the police and the local authority at the time they occurred. They are currently a matter of police investigation to see if there are any connections between them, meaning we cannot comment on them in detail. At this stage, it has not been possible to confirm whether the losses in question were the result of theft or other causes.
We have put in place policy changes in August meaning that all reports of losses and theft, no matter what level, are reported to our safeguarding lead professionals. These safeguarding leads will then review all data, to monitor for potential safeguarding issues such as financial abuse, to review patterns and to advise the Trust on actions to be taken. This team, working with the local security management specialist, will support the Trust’s operational teams in escalating concerns to the police – not just as an individual case but at a Trust-wide level.
We will learn from these incidents and ensure that reporting systems are used effectively, so that decisive action is always taken to protect patients and learning in one area is considered across all Trust services. We have appointed new non-executive directors who, at induction, will be appointed key roles; one will specialise in security management and attend the health and safety committee. They will be a key supporter in this work, giving feedback on the system and processes and whether they are assured that the system has been strengthened.
Application of the Mental Capacity Act
We are providing more training and instruction for staff across our services in how to record and apply the Mental Capacity Act. For example we are producing training videos that are specific to different service areas so that staff understand how the act applies directly to the people in their care. We have appointed an external Mental Capacity Act administrator who is an expert in this area, who will be leading this work and ensuring our systems of monitoring are tightened, as well as providing teaching sessions.
We have also invested additional funds in a clinical skills tutor model. As part of that model, the tutor specialising in the application of Mental Capacity Act will be rostered to work across all seven days of the week, to teach staff and give direct feedback on their clinical competence and record-keeping. In addition they will provide compliance audits on our staff’s improvement.
Implementing the Mental Health Act
We are also providing more training and instruction to staff on the Mental Health Act. The particular focus has been on ensuring at all times that the responsible clinicians and clinical team members always provide people with details of their Community Treatment Order rights, and that these are recorded in one area, with all records documenting if these rights are fully understood. In addition, some of our ward staff have specific and particular requirements to improve their knowledge of the Mental Health Act and how they record rights as they move from paper records to electronic records.
Our Mental Health Act team will work on improving its systems and processes and reporting to the Trust’s Mental Health Act Committee to ensure that all aspects of the Code of Practice are followed and key elements are monitored. The team will make sure that assurance reports to the committee address all learning from the CQC inspection.
Providing personalised care
We accept that our care plans must be written in partnership with individual service receivers, and in the first person (“I will” not “He/she will”). We have put in place additional resource to train our staff, and to ensure that all care plans are up-to-date and developed in partnership with service receivers. We are applying the same approach to our safety planning; we are currently developing a new approach that will involve service receivers in deciding how they can best keep themselves safe, and this will be in place across the Trust by March 2017.
We take the findings of the CQC inspection report extremely seriously. Nothing is more important to us than the safety and wellbeing of the people who use our services. Moreover, supporting our staff and listening to their views – ensuring their learning and their voices are heard – is key to our future success.
If you have any concerns about issues raised in the report, please feel you can share your thoughts with us – talk to your care co-ordinator or link worker, or contact our Patient Experience team on 0800 027 2128.
You can also contact us by email:
Ifti Majid, Acting Chief Executive
Carolyn Green, Director of Nursing and Patient Experience