Chief Inspector of Hospitals publishes his findings on Calderstones Partnership NHS Foundation Trust

England's Chief Inspector of Hospitals has published his first report on the quality of care provided by Calderstones Partnership NHS Foundation Trust.

Calderstones Partnership NHS Foundation Trust was inspected between 8 and 11 July 2014 using a new approach to inspections which has been introduced by CQC to provide a more detailed picture of healthcare than ever before.

Overall the report concludes that the trust must take urgent action to address some serious deficiencies in the quality of care that it provides to the vulnerable people who use its services. Although the inspection team observed instances of staff delivering care in a kind and compassionate manner, the trust faced a number of challenges.  These included failure to maintain cleanliness and hygiene on the wards, problems with levels of staffing on some wards, poor medicines management, the frequency with which patients were restrained in the face-down position, and a failure to adequately monitor the use of the Mental Health Act.

The visiting inspection team included CQC inspectors and a variety of specialists including learning disability and forensic consultant psychiatrists, junior doctors, learning disability nurses, social workers, Mental Health Act Commissioners, consultant psychologists, patient “experts by experience”, family carer "experts" and senior NHS managers, an advocate and a learning disability nurse consultant.

The inspection team found that the trust must improve in a number of areas including:

• Some of the wards and seclusion rooms that inspectors visited were dirty or were unsafe. This included facilities at Woodview and West Drive at the main hospital complex.
• Inspectors found deficiencies in infection control procedures on some wards with a lack of infection control audits at ward level, no hand-washing facilities in areas where medicines were dispensed and incorrect labelling and use of sharps containers. The trust must also ensure that it adheres to best practice for food labelling, monitoring of fridge temperatures and the maintenance of equipment.
• Nurses frequently used physical restraint to manage the behaviour of patients. On more than one-quarter of occasions when physical restraint was used in the six months prior to the inspection, the patient was held on the floor in a face-down position. This is known to be the least safe method of restraint and its use is contrary to recently introduced national guidance.
• The trust must ensure there are sufficient numbers of suitably qualified, skilled and experienced staff, particularly at night. A single nurse provided night-time cover to wards at 5 Chestnut Drive, North Lodge and 14/16 Daisy Bank. The arrangements to provide back-up in the event of an emergency on these wards did not sufficiently mitigate the risk to these members of staff
• The trust has to ensure that there are improvements in practices and adherence to the Mental Health Act. For example inspectors found that wards where information leaflets were out of date and did not incorporate amendments to the MHA made in 2007, certificate of consent to treatment and certificate of second opinion forms that were out of date, incorrectly stored or not followed.

One area of good practice that inspectors identified was the patient led complaints summary being trialled on Gisburn Lodge. The trust had a complaints system which could monitor trends across wards.

Staff on most wards provided people with information about how they could raise complaints or concerns and most people told inspectors that they felt able to raise any concerns and were confident that they would be listened to.

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

"Calderstones Partnership NHS Foundation Trust is a unique organisation. It is the only NHS trust that provides care exclusively for people with learning disabilities. It is also unusual in that all of its patients are cared for in a hospital ward and almost all detained under the Mental Health Act. More than 40 per cent of the patients at Calderstones have been there for more than five years. The Government is committed to ensuring that people with learning disabilities are not kept in hospital for any longer than is absolutely necessary.

"Against this backdrop the trust faces some major challenges. The trust has difficulty recruiting nursing staff and many posts were vacant. It therefore was relying relied heavily on the use of agency and bank nurses.  Although the trust was good at providing and monitoring basic ‘mandatory’ training for its staff, it was less good at providing the training required to meet the care needs that are particular to the specific problems of the patient group admitted to Calderstones.

"The conditions that we found on some of the wards were unacceptable. It should go without saying that a hospital ward should be clean. It is even more troubling when these wards are also, in effect, people’s homes.

"Many of the people admitted to Calderstones have severe mental health problems and have a history of behaviour that has put themselves and/or others at risk. Despite that, we were surprised at the number of occasions when staff had resorted to physical restraint. I would urge the trust to work tirelessly to find alternative ways of helping the people they care for to gain control over their more risky behaviours. The staff at Calderstones must also ensure that when restraint is used it is by the safest means and that there is proper medical back-up to minimise the possibility of harm to the patient.

"Some of the trust board members, including the chief executive and chair, were relatively new in post. They have a substantial task on their hands to bring the quality of care at Calderstones Partnership NHS Foundation Trust up to modern standards and to address the failings identified in this report.  To do this they will need help from the clinical commissioning groups, local councils and other members of the local health and social care community."

Ends

For media enquiries, call David Fryer, Regional Engagement Manager, 07901 514220 or the CQC press office on 020 7448 9401 during office hours or out of hours on 07917 232 143.

For general enquiries, call 03000 61 61 61.