England’s Chief Inspector of Hospitals has rated the services provided by Birmingham and Solihull Mental Health NHS Foundation Trust as Requires Improvement following an inspection by the Care Quality Commission.
The CQC inspected the core services provided by the trust between 27 and 31 March 2017. The trust provides mental health services to 1.2 million people in the West Midlands, operated from over 50 sites. The services provided by the trust are used by children and adolescents, young adults, acute adults and older adults.
The trust was previously rated Good and this most recent inspection was carried out in order to check on improvements in all areas. A team of inspectors, which included a variety of specialists and experts by experience, visited hospital wards and community based mental health services.
The CQC has rated the trust as Requires Improvement overall. It was rated as Good for being caring and responsive and Requires Improvement for being safe, effective and well led.
CQC’s Deputy Chief Inspector of Hospitals (and lead for mental health), Dr Paul Lelliott, said:
“Our inspectors found that the trust needed to make a number of improvements to bring its services back to a level that would earn a rating of good overall. We gave immediate feedback to the trust following the inspection and this report presents the detail of our findings, our ratings and our recommendations.
“It was disappointing to see that the trust’s rating had declined from good to requires improvement and the trust must now ensure improvements are made in order to provide services that are safe, effective, caring, responsive and well-led.
“Feedback from staff and evidence from the most recent NHS staff survey suggested a disjoint between the board and staff at service level. Staff groups in several areas reported feeling under-valued and being unheard concerning key decisions and service re-design.
“The Board Assurance Framework did not focus on strategic risks and instead was an extension of the corporate risk register. This meant that the board were unable to provide robust evidence of an understanding of the trust’s corporate risks.
“The oversight and safety of medicines management was compromised as the trust did not have a medicines safety officer in post. The trust policy concerning rapid tranquilisation was also out of date and did not reflect updated guidance from the National Institute for Health and Care Excellence.
“However, we found some areas of good practice including the trust’s effective involvement with external stakeholders in the planning and delivery of services. The trust had embarked on a partnership with other providers to establish a forensic pathway with support from NHS England.
“Staff throughout the organisation, were caring, compassionate, kind and treated patients with dignity and respect. Feedback from patients and carers was positive and highlighted the staff as a caring group”.
“Throughout our visit, we saw staff interacting with patients in a positive, friendly and respectful manner and most of the patients that inspectors spoke to were positive in their views of staff. They also observed staff speaking about Patients positively in referral and multidisciplinary meetings.
“The trust leadership is aware of what it needs to do to bring about improvement in the areas identified. We will continue to monitor the trust and our inspectors will return at a later date to check on what progress has been made.”
The CQC has told the trust to take action in several areas, including:
- The trust must ensure that effective processes are in place to monitor the quality of recorded information for all patients assessed in the health based places of safety.
- The trust must consider using mirrors on wards with multiple blind spots in order to mitigate against ligature risks to patients.
- The trust must ensure that capacity to consent to treatment forms are completed and decision specific.
- Consent to treatment must be routinely established and recorded within care records in the community mental health services for children and young people.
- The trust must ensure healthcare assistants receive training in the Mental Health Act and Mental Capacity Act.
- The trust must undertake active and individual assessment of risks posed to patients who return from leave and use this to base decision on search.
The CQC inspection team also found a number of areas of good practice, including:
- At Reaside hospital, patients could engage in further education and obtain qualifications up to City and Guilds level. There was partnership working with education bodies to ensure that patients could develop skills and qualifications that could be useful to them on their return to the community.
- Patients could access a wide variety of group therapies to support their wellbeing and recovery.
- On the older people’s mental health ward, there were ‘All about Me’ documents which gave a summary of patient’s likes, dislikes, preferences, and life history. These were used when a patient was discharged and gave any new care setting a good personalised view of the patient to help ensure quality, person-centred care.
- Inspectors saw individual cases of good practice across the forensic services. The trust has developed a project called “Dragons Den” where staff can develop a business plan to create new ways of working and approach the trust for funding.
- Staff at the looked after children services, had delivered adoption preparation training. This contained clinical advice on attachment, brain development and trauma and delivered a fostering resilience programme to parents beginning their fostering journey.
- The memory assessment service was accredited with the Royal College of Psychiatrists. It worked closely with the Alzheimer’s Society who they commissioned to provide follow-up support and information along with information about local sources of support.
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