Chief Inspector of Hospitals publishes his first findings on Surrey and Borders Partnership NHS Foundation Trust

England's Chief Inspector of Hospitals, Professor Sir Mike Richards, has published his first report on the quality of services provided by Surrey and Borders Partnership NHS Foundation Trust.

Inspectors visited the trust in July. They inspected acute inpatient services and crisis teams for adults of working age, the psychiatric intensive care unit (PICU) in Langley wing at Epsom hospital, and the three places of safety located in Langley Wing, Epsom General Hospital, Wingfield Ward, Ridgewood Centre, Frimley and St Peter’s.

CQC also inspected inpatient and community services for older people, and visited a sample of community teams across a range of services, including services for adults, services for people with learning disabilities, and services for people with eating disorders.

People told inspectors that most staff treated them with dignity, kindness and respect, and many staff said that they enjoyed working for the trust. Collaborative working with agencies such as social services was good, and the trust was always looking for ways to improve the services it provided. Some services provided very good care, and CQC found that the trust was led by a committed senior team who had a reputation internally for being open and accessible.

Inspectors also found, however, that governance processes were not as robust as they should be. Many of these systems were new, and there was a risk that these might not always identify poorly performing services quickly enough to allow the necessary improvements to be made in a timely way. While the trust understood broad areas of risk, it did not always know all the risks at ward and team level.

CQC found that this led to variations in the quality of care across services and divisions and the need for improvements in some areas, particularly the PICU, and the Victoria ward, Farnham Road Hospital, which provides care to older people.

The full reports are available on the CQC wesite here.

Good practice was found in a number of areas of the trust, including:

• A comprehensive clinical strategy which was valued by staff and provided services with a strategic framework.
• The acute admission wards, all but one of which had been accredited by the Royal College of Psychiatrists’ Accreditation for Inpatient Mental Health Services scheme.
• Health-based places of safety run by the trust, which did not exclude people due to intoxication, and there were policies in place to ensure they could meet the needs of these patients. There were also specific procedures in place for the care of people under the age of 18 years.
• The criminal justice liaison and diversion service, an innovative service which had provided specialist mental health awareness training to police custody officers.
• The child and adolescent mental health services (CAMHS) youth advisors, an innovative user-led service run by young people who use/have recently used the service. The CAMHS service also ran a targeted mental health in schools approach that worked to support school staff to recognise young people with emerging mental health and emotional needs, and provide access to early advice and consultation from a mental health professional.

CQC also identified a number of areas in which improvements were required, including:

• At the PICU, making sure that staff respond promptly to people’s requests and engage with them more proactively. Patients detained under Section 2 of the Mental Health Act must have their rights explained to them on a weekly basis and recorded, and agency staff must be trained to an appropriate standard in the use of restraint.
• At both the PICU and the Mid Surrey assessment and treatment centre, making sure that staff have a clear understanding of the definition and use of seclusion, and that resuscitation equipment is regularly monitored.
• In older people’s services, regular physical health checks must take place on inpatient wards. The trust must also make sure that assessments are in place to identify the risk of falls and tissue viability for people on these wards.
• In CAMHS services, the trust must ensure that all staff know how to report incidents and are made aware of the findings of investigations.

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

“Surrey and Borders Partnership NHS Foundation Trust provides a wide range of services to a large population across Surrey and surrounding areas. We found that they were doing a lot of things very well – but that improvements were required in a number of areas.

“We saw that the leadership team was committed to delivering good care, as were staff. Many people using trust services told us that staff treated them with respect, and we saw that the trust worked well with other services in Surrey to support people.

“However, we also found that the quality of services was variable, that the procedures that the trust used to ensure quality and safety did not always identify problems and that, when they did, improvements could have been made more quickly.

“We have told the trust to make a number of improvements because people deserve to receive treatment and care from services which are consistently safe, effective, caring and responsive to their needs.

“We will return in due course to check the trust has made the improvements required.” Under CQC's new inspection regime, a team of 50 people which included doctors, nurses, hospital managers, trained members of the public, a variety of specialists, CQC inspectors and analysts spent four days at the trust.

CQC will check that the required improvements have been made.

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