England's Chief Inspector of Hospitals has found a number of improvements at Derbyshire Healthcare NHS Foundation Trust but says more work is needed following an inspection by the Care Quality Commission.
The trust was inspected between 22 May and 13 July and, as a result, is rated as Requires Improvement overall.
Derbyshire Healthcare NHS Foundation Trust is rated as Requires Improvement for being safe, effective, responsive, and well-led and Good for being caring. It’s rating for well-led had improved from its previous rating of Inadequate.
The trust provides mental health and community services to around one million people in Derbyshire.
CQC’s Acting Head of Hospital Inspections (mental health), Kathryn Mason, said:
“Our inspectors found a number of improvements had been made at the trust but further work was needed for the trust to achieve a rating of Good overall.
“Inspectors found staff at Derbyshire Healthcare NHS Foundation Trust were caring and treated patients with dignity and respect. While we found, a number of improvements had been made at the trust and we witnessed areas of outstanding practice, more work was needed to ensure the trust provided the service people should be able to expect.
“The trust needs to ensure it improves its management of risk, how it carries out observations and how it recognises and reports safeguarding issues. It must ensure its electronic records system is fit for purpose, that there is robust programme of clinical audits and that waiting times are reduced. Inspectors also highlighted that environments used by patients need to be safe and this includes ensuring there are sufficient, suitably qualified staff available to care for people.
“We have reported our inspection findings back to the trust and it knows what it needs to do to make sure the necessary improvements are made. We will return to check on its progress.”
The inspection team found several areas where improvements must be made, including that effective policies must be in place to allow staff to identify, escalate and treat deteriorating patients (including sepsis).
The trust must ensure all blind spots and points where a ligature could be anchored are reduced in health based places of safety.
The trust must ensure all staff consistently check the emergency equipment so it is safe to use and that there are sufficient staff to safely support people.
Staff must robustly assess and handover risks relating people using the service and all documents used by staff to record people’s risks must be available electronically for all staff to access. Staff must complete and regularly update patients’ assessments and care plans.
The trust must ensure staff recognise, report and follow up safeguarding issues and that medicines management practices are safe and effective.
Observations and checks required when a patient is secluded must be completed and recorded. A robust programme of clinical audits was also needed and any identified actions from these must be addressed.
There must be a plan in place to show how waiting lists for care coordinators, psychology and outpatients would be reduced. Additionally, the trust must ensure average waiting times for speech and language therapy are reduced.
The trust must ensure all teams checked fridge and room temperatures daily and that prescription charts contain allergy information.
Inspectors also witnessed some outstanding practice across the trust, including the purpose-built seclusion suite at Radbourne Unit. This had an adapted room to meet the needs of people with limited mobility. Staff could also offer sensory-based interventions to secluded patients, such as music and aromatherapy that helped them relax.
There were recovery hubs with a range of facilities and equipment, and a structured programme of therapeutic activities. Staff and patients spoke highly of the hubs.
Staff collaborated with a national body to create a simplified and pictorial form to help patients and their families to recognise and understand what constitutes abuse. We saw this was an area of innovative practice to support the patient group and tackle abuse.
Derbyshire Healthcare NHS Foundation Trust provides community services to children and families, mental health services to people with learning disabilities and people with substance misuse needs.
Our inspectors found a number of improvements had been made at the trust but further work was needed for the trust to achieve a rating of Good overall
CQC’s Acting Head of Hospital Inspections (mental health), Kathryn Mason