Chief Inspector of Hospitals finds that Sussex Partnership NHS Foundation Trust requires improvement

England's Chief Inspector of Hospitals has told Sussex Partnership NHS Foundation Trust that it must improve the quality of its services following an inspection by the Care Quality Commission.

Overall the trust has been rated as Requiring Improvement. Although the trust provided services that were Good for being caring, improvements were needed for services to be consistently safe, effective, responsive and well led.

During the inspection in January a team of inspectors and specialists including doctors, nurses, managers and experts by experience visited all of the trust’s 41 hospital wards and 13 community mental health services. The trust’s five places of safety and six crisis services were also inspected.

Sussex Partnership NHS Foundation Trust provides NHS mental health, learning disability, substance misuse and prison healthcare services across Sussex, as well as community mental health services for children and young people in parts of Kent and Hampshire.

Full reports on all core services are available at www.cqc.org.uk/provider/RX2.

Dr Paul Lelliott, CQC’s Deputy Chief Inspector of Hospitals, said:

“We have found considerable variation in the quality of the services provided by Sussex Partnership NHS Foundation Trust.

“While most community-based services were good, some areas of care in learning disability and older people’s inpatient services were Inadequate. These services require urgent attention to bring them up to acceptable standards.

"I was disappointed at the findings of ward environments that were not clean, did not ensure the privacy and dignity of patients by providing separate facilities for men and women, and did not always ensure the safety of patients.

“The rehabilitation service at Hanover Crescent was our most immediate concern. Here we found serious problems relating to cleanliness, infection control and management of risks. The trust responded promptly to our findings by closing the unit to new admissions.

“We were also concerned that the trust had no plan in place to tackle the relatively high rate of suicide in Sussex. Whilst we recognise that other agencies must be involved in developing a suicide prevention plan, we would urge the trust to initiate urgent work with public health and community agencies to address this.

“At the time of the inspection, some of the senior team were new in post. It was reassuring to find that they had themselves identified many of the problems. . We have seen encouraging signs of improvement in the four months since the inspection.

"People are entitled to receive treatment and care in services which are consistently safe, effective, caring and responsive to their needs. We will return in due course to check that the improvements needed have been made.”

Inspectors found community mental health services for adults of working age, older people and people with a learning disability or autism were Good. Inspectors found nearly every service to be caring, with staff at all levels committed to providing good patient care. Forensic inpatient and secure wards, and specialist community mental health services for children and young people were rated Outstanding for being caring.

There was a shortage of beds across adult and older people’s wards This meant that often it was necessary for patients to access inpatient care some distance from their home.

A number of wards were mixed with some wards having separate corridors for men and women but women could only access bathroom and toilet facilities by passing through the male areas. Doors were left open between male and female corridors. At the time of the inspection, CQC asked the trust to close, Hanover Crescent in Brighton, part of the rehabilitation service, because of their concerns that it was an unsafe environment with poor conditions of hygiene and low levels of staffing. The trust did this immediately.

Inspectors found in child and adolescent services there were of concern in relation to ligature points in bathrooms that could endanger people at risk of suicide. Although these had been identified by the trust they were not being addressed as a priority. In child and adolescent services there were significant delays in accessing services, although the trust has been working to reduce this. Waiting times for routine treatments, in relation to anxiety, low mood and autistic spectrum conditions could take up to a year.

The inspection team identified 15 areas where the trust must make improvements including:

• The trust must ensure medicines management is conducted in accordance with trust policies
• The trust must ensure staff are appropriately trained. Staff had not received mandatory training within the timescales set by the trust.  This included basic life support training and safeguarding training.
• The trust must ensure that people with learning disability have physical health action plans in place.
• The trust must take action to bring the seclusion rooms up to required standard in the inpatient unit for people with a learning disability.

Overall, inspectors identified a number of areas of outstanding practice, including:

• The A&E liaison team and the Brighton urgent response team won the 2013 Guardian Healthcare Innovation award for the Brighton urgent response project in both A&E and in responding to GP referrals in the community. The project led to a 50 per cent reduction in the number of patients with mental health problems being admitted to the observation ward at the Royal Sussex County Hospital.
• A staff member at the trust set up a football team which involved in-patients, patients in the community and staff. They used training facilities at the local professional football club and had organised a tournament involving 16 teams from different mental health services in the local area.
• Most rehabilitation services employed peer support workers for several hours a week. They often facilitated community meetings with patients. Peer support workers provided a unique perspective on the service provided and worked well with patients to support their rehabilitation.

The reports which CQC publish today are based on a combination of its inspection findings, information from CQC’s Intelligent Monitoring system, and information provided by patients, the public and other organisations including Healthwatch.

Last week the Care Quality Commission presented its findings to a local quality summit, including NHS commissioners, providers, regulators and other public bodies. The purpose of the quality summit is to develop a plan of action and recommendations based on the inspection team’s findings.

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