The Care Quality Commission (CQC) has published a report following an inspection at Devon Partnership NHS Trust.
The inspection was carried out at the trust’s acute wards for adults of working age, psychiatric intensive care unit (PICU), community services for adults of working age and forensic inpatient and secure wards as part of CQC’s continual checks on the safety and quality of healthcare services. An inspection of the well-led domain was also carried out.
Inspectors found good care was being provided to people using services, but some improvements were needed, particularly at the forensic inpatient and secure wards.
Following the inspection, the ratings for acute wards for adults of working age and the PICU went up from requires improvement to good. Community services for adults of working age went up from inadequate to requires improvement. The rating for forensic inpatient and secure wards went down from outstanding to requires improvement.
Overall, the services were rated as good for being effective, caring, responsive, well-led and safe. The trust’s overall rating remains unchanged as good.
Karen Bennett-Wilson, CQC’s head of hospital inspection for mental health, said:
“When inspectors visited Devon Partnership NHS Trust, they were pleased to see that most areas had improved despite the significant pressures caused by the pandemic which is good news for people using these services.
“Since our last inspection, there has been several changes to the leadership team, including a new chair and non-executive directors. The executive team has been strengthened and now has a wide range of skills and high level of awareness of the priorities and challenges facing the trust and how to address these.
“We saw clear improvements in the way the community mental health teams for adults of working age monitored patients on waiting lists to keep them safe and responded to any changing risks.
“Improvements had also been made to the safety of the environment in the acute wards and psychiatric intensive care unit. The trust had introduced simulation training in ligature risk management with over 100 staff now trained in this area. Cameras had also been installed in blind spots on wards to enable staff to safely observe patients. This meant the premises were safer for patients and staff knew how to identify any potential risk areas.
“There are, however, areas where improvements must be made and maintained. In the forensic inpatient and secure wards, morale was very low with staff feeling stressed, exhausted and burnt out following the demands of the pandemic. Before the inspection, CQC received whistleblowing concerns from staff who felt their views were not listened to or welcomed. The service had a high number of nursing vacancies which added to the pressure of existing staff. In addition, care plans in this area were inconsistently completed and did not reflect the patient’s involvement.
“We have reported our findings to the trust and are pleased that the strong commitment from all at the trust to deliver good services has resulted in higher standards of care for people across most areas. The provider must now ensure these changes are sustained and the necessary improvements are made in the areas we have highlighted.”
Following the inspection, the trust must ensure the following improvements are made:
At the community-based mental health services for adults of working age:
- Waiting times must be managed effectively and all patients must be seen within the required waiting times target.
- Patients' physical health must be monitored in accordance with National Institute for Health and Care Excellence guidance.
- Patients must be able to access psychological therapy in a timely manner.
At the forensic inpatient and secure wards:
- There must be enough suitably qualified and experienced staff to meet patient care and treatment needs.
- The trust must actively encourage staff to speak up, and have appropriate means to support this, about the quality of the services. This includes ensuing there is an open and transparent culture in which staff can raise their concerns to senior leaders without fear of retribution and reprisal.
At the acute wards for adults of working age and psychiatric intensive care units:
- The trust must ensure that ward ligature risk assessments also include mitigation that is reflective of what staff are doing on the wards.
Inspectors found examples of outstanding care across services, including:
- Staff and patients on Cofton ward at Langdon Hospital were one of three locations countrywide participating in a sexual safety pilot programme. The aim of the programme is to make wards a safe space for staff and to recognise when a person is sexually inappropriate both physically and verbally.
- The trust had a sexual safety board and there was artwork around wards linked to this. Staff discussed sexual safety in team meetings and gave out information cards for patients and staff.