Southern Health NHS Foundation Trust rated as Requires Improvement by Chief Inspector of Hospitals

England’s Chief Inspector of Hospitals has published his first report on the quality of the services provided by Southern Health NHS Foundation Trust following an inspection by the Care Quality Commission.

Overall, the trust has been rated as Requires Improvement – although the trust was rated as Good for being caring and responsive. The specialist perinatal service based at Winchester was rated Outstanding in all areas.

Southern Health NHS Foundation Trust delivers a wide range of community healthcare, mental health, learning disability and adult social care services from locations in Hampshire, Oxfordshire and Buckinghamshire.

A team of CQC inspectors, expert specialist advisors and people who have experience of using services or caring for someone who uses services spent four days at the trust in October. CQC has published 17 separate reports on the services provided by the trust in hospitals, in clinics, and in the community.

Full reports including ratings for all core services are available on this website. 

At the time of the inspection, the trust was in the process of redesigning the way it delivers its services, and these changes were at a relatively early stage of development. Although the trust leadership had been strengthened by the appointment of new directors and senior managers, many had only been in post a short time.

The inspectors found a lack of consistency across the trust. While some community health and mental health services were good, there was significant variation in the quality of services.

The numbers of staff and skill mix on some mental health wards were a concern. Staff reported working longer than their contracted hours in order to deliver care to patients and said that the needs of patients was not always taken into account when deciding the numbers of staff.

Community healthcare services did not always have enough staff and the gaps were not always covered. This meant some missed visits to patients and long waiting times for treatment by a therapist.

At the time, inspectors raised their concerns about the safety of patients at Ravenswood House, a secure hospital at Fareham. Although there are plans to relocate the service, inspectors were concerned that the building was unfit for use. Some wards had ligature points that could endanger people at risk of suicide.

CQC has identified a number of specific areas where the trust must improve. As a first step, the trust must provide a plan setting out how it will address each requirement.

• On the adolescent mental health wards and forensic services, the trust must ensure there is an appropriate policy for the use of restraint and that there is appropriate recording of this.
• The trust must ensure appropriate measures are taken to mitigate and manage ligature risks, that might endanger patients at risk of suicide,on forensic and secure wards at Ravenswood House and Southfield.
• On wards for people with learning disabilities or autism, the trust must ensure that all staff are aware of adverse incidents that have taken place in the service and where relevant in other parts of the trust and the learning from these incidents
• The trust must ensure there are sufficient numbers of suitably qualified, skilled and experienced staff to provide end of life care to all patients that need it.

Despite these problems, in all of the services visited, inspectors found kind, sensitive and caring staff who were passionate about their work and committed to delivering high quality care. Patients and families were positive about the way staff communicated with them, the time staff took to listen, and their caring nature. Inspectors also identified a number of specific areas of good practice and some exceptional practice across the trust, including:

• The mother and baby unit at Melbury Lodge in Winchester engaged in preventative work and raised awareness of the needs of women who experience mental health needs during and after pregnancy. They used a range of creative methods to engage and support women using the service.
• The trust had introduced a ‘recovery college’ for people with mental health problems and staff working in mental health services. The college offers courses designed to increase knowledge of recovery and self-management
• A leadership development programme called Going Viral had been developed, with the aim of supporting approximately 1,000 senior leaders across the trust to redesign and integrate their services to enhance every aspect of the patient experience.
• The trust had a clear commitment to progressing research and had conducted 45 research studies between 2012/14 involving approximately 800 people
• A system of peer review had recently been established. The process involved a small review team from another service or area within the trust visiting a ward or team and assessing it against set criteria.
• Inspectors found a clear commitment to equality and diversity: the trust had won several national awards.

Dr Paul Lelliott, Deputy Chief Inspector of Hospitals (lead for mental health), said:

“Although we found a number of specific problems that must be put right, Southern Health NHS Foundation Trust provides some good and even some outstanding services to a large population. We found a committed and caring workforce that was, for the most part, meeting the needs of all those people safely and effectively.

“The trust has reconfigured its learning disability services in Oxfordshire, closing inpatient beds at Slade House. Despite this, some concerns remain and people are worried by the uncertainty over the future of the service.

“In common with some other mental health and community health trusts, Southern Health, is struggling to recruit good staff - the general shortage of newly qualified mental health nurses had contributed to this problem.

“We received many comments throughout the inspection about access to crisis services for adults, particularly out of hours. Patients and their carers told us that they had to go to A and E departments because crisis services which should have been provided by the trust were not available.

“The trust have told us they have listened to our inspectors’ findings and already begun to take action. Southern Health NHS Foundation Trust had been going through a significant period of change. I would hope that when we return to re-inspect in due course we will find that those changes have been embedded further alongside the improvements that we have identified.”

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